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Publisher: Elsevier   (Total: 3049 journals)

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Showing 1 - 200 of 3089 Journals sorted alphabetically
A Practical Logic of Cognitive Systems     Full-text available via subscription   (Followers: 7)
AASRI Procedia     Open Access   (Followers: 15)
Academic Pediatrics     Hybrid Journal   (Followers: 25, SJR: 1.402, h-index: 51)
Academic Radiology     Hybrid Journal   (Followers: 22, SJR: 1.008, h-index: 75)
Accident Analysis & Prevention     Partially Free   (Followers: 86, SJR: 1.109, h-index: 94)
Accounting Forum     Hybrid Journal   (Followers: 25, SJR: 0.612, h-index: 27)
Accounting, Organizations and Society     Hybrid Journal   (Followers: 30, SJR: 2.515, h-index: 90)
Achievements in the Life Sciences     Open Access   (Followers: 4)
Acta Anaesthesiologica Taiwanica     Open Access   (Followers: 5, SJR: 0.338, h-index: 19)
Acta Astronautica     Hybrid Journal   (Followers: 363, SJR: 0.726, h-index: 43)
Acta Automatica Sinica     Full-text available via subscription   (Followers: 3)
Acta Biomaterialia     Hybrid Journal   (Followers: 25, SJR: 2.02, h-index: 104)
Acta Colombiana de Cuidado Intensivo     Full-text available via subscription   (Followers: 1)
Acta de Investigación Psicológica     Open Access   (Followers: 2)
Acta Ecologica Sinica     Open Access   (Followers: 8, SJR: 0.172, h-index: 29)
Acta Haematologica Polonica     Free   (SJR: 0.123, h-index: 8)
Acta Histochemica     Hybrid Journal   (Followers: 3, SJR: 0.604, h-index: 38)
Acta Materialia     Hybrid Journal   (Followers: 228, SJR: 3.683, h-index: 202)
Acta Mathematica Scientia     Full-text available via subscription   (Followers: 5, SJR: 0.615, h-index: 21)
Acta Mechanica Solida Sinica     Full-text available via subscription   (Followers: 9, SJR: 0.442, h-index: 21)
Acta Oecologica     Hybrid Journal   (Followers: 10, SJR: 0.915, h-index: 53)
Acta Otorrinolaringologica (English Edition)     Full-text available via subscription   (Followers: 1)
Acta Otorrinolaringológica Española     Full-text available via subscription   (Followers: 3, SJR: 0.311, h-index: 16)
Acta Pharmaceutica Sinica B     Open Access   (Followers: 1)
Acta Poética     Open Access   (Followers: 4)
Acta Psychologica     Hybrid Journal   (Followers: 24, SJR: 1.365, h-index: 73)
Acta Sociológica     Open Access  
Acta Tropica     Hybrid Journal   (Followers: 6, SJR: 1.059, h-index: 77)
Acta Urológica Portuguesa     Open Access  
Actas Dermo-Sifiliograficas     Full-text available via subscription   (Followers: 4)
Actas Dermo-Sifiliográficas (English Edition)     Full-text available via subscription   (Followers: 3)
Actas Urológicas Españolas     Full-text available via subscription   (Followers: 4, SJR: 0.383, h-index: 19)
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Actualites Pharmaceutiques     Full-text available via subscription   (Followers: 5, SJR: 0.141, h-index: 3)
Actualites Pharmaceutiques Hospitalieres     Full-text available via subscription   (Followers: 4, SJR: 0.112, h-index: 2)
Acupuncture and Related Therapies     Hybrid Journal   (Followers: 4)
Acute Pain     Full-text available via subscription   (Followers: 13)
Ad Hoc Networks     Hybrid Journal   (Followers: 11, SJR: 0.967, h-index: 57)
Addictive Behaviors     Hybrid Journal   (Followers: 15, SJR: 1.514, h-index: 92)
Addictive Behaviors Reports     Open Access   (Followers: 6)
Additive Manufacturing     Hybrid Journal   (Followers: 7, SJR: 1.039, h-index: 5)
Additives for Polymers     Full-text available via subscription   (Followers: 21)
Advanced Cement Based Materials     Full-text available via subscription   (Followers: 3)
Advanced Drug Delivery Reviews     Hybrid Journal   (Followers: 132, SJR: 5.2, h-index: 222)
Advanced Engineering Informatics     Hybrid Journal   (Followers: 11, SJR: 1.265, h-index: 53)
Advanced Powder Technology     Hybrid Journal   (Followers: 17, SJR: 0.739, h-index: 33)
Advances in Accounting     Hybrid Journal   (Followers: 9, SJR: 0.299, h-index: 15)
Advances in Agronomy     Full-text available via subscription   (Followers: 15, SJR: 2.071, h-index: 82)
Advances in Anesthesia     Full-text available via subscription   (Followers: 26, SJR: 0.169, h-index: 4)
Advances in Antiviral Drug Design     Full-text available via subscription   (Followers: 3)
Advances in Applied Mathematics     Full-text available via subscription   (Followers: 6, SJR: 1.054, h-index: 35)
Advances in Applied Mechanics     Full-text available via subscription   (Followers: 11, SJR: 0.801, h-index: 26)
Advances in Applied Microbiology     Full-text available via subscription   (Followers: 22, SJR: 1.286, h-index: 49)
Advances In Atomic, Molecular, and Optical Physics     Full-text available via subscription   (Followers: 16, SJR: 3.31, h-index: 42)
Advances in Biological Regulation     Hybrid Journal   (Followers: 4, SJR: 2.277, h-index: 43)
Advances in Botanical Research     Full-text available via subscription   (Followers: 3, SJR: 0.619, h-index: 48)
Advances in Cancer Research     Full-text available via subscription   (Followers: 25, SJR: 2.215, h-index: 78)
Advances in Carbohydrate Chemistry and Biochemistry     Full-text available via subscription   (Followers: 9, SJR: 0.9, h-index: 30)
Advances in Catalysis     Full-text available via subscription   (Followers: 5, SJR: 2.139, h-index: 42)
Advances in Cell Aging and Gerontology     Full-text available via subscription   (Followers: 4)
Advances in Cellular and Molecular Biology of Membranes and Organelles     Full-text available via subscription   (Followers: 12)
Advances in Chemical Engineering     Full-text available via subscription   (Followers: 27, SJR: 0.183, h-index: 23)
Advances in Child Development and Behavior     Full-text available via subscription   (Followers: 10, SJR: 0.665, h-index: 29)
Advances in Chronic Kidney Disease     Full-text available via subscription   (Followers: 9, SJR: 1.268, h-index: 45)
Advances in Clinical Chemistry     Full-text available via subscription   (Followers: 29, SJR: 0.938, h-index: 33)
Advances in Colloid and Interface Science     Full-text available via subscription   (Followers: 18, SJR: 2.314, h-index: 130)
Advances in Computers     Full-text available via subscription   (Followers: 16, SJR: 0.223, h-index: 22)
Advances in Dermatology     Full-text available via subscription   (Followers: 12)
Advances in Developmental Biology     Full-text available via subscription   (Followers: 11)
Advances in Digestive Medicine     Open Access   (Followers: 7)
Advances in DNA Sequence-Specific Agents     Full-text available via subscription   (Followers: 5)
Advances in Drug Research     Full-text available via subscription   (Followers: 22)
Advances in Ecological Research     Full-text available via subscription   (Followers: 45, SJR: 3.25, h-index: 43)
Advances in Engineering Software     Hybrid Journal   (Followers: 26, SJR: 0.486, h-index: 10)
Advances in Experimental Biology     Full-text available via subscription   (Followers: 7)
Advances in Experimental Social Psychology     Full-text available via subscription   (Followers: 43, SJR: 5.465, h-index: 64)
Advances in Exploration Geophysics     Full-text available via subscription   (Followers: 3)
Advances in Fluorine Science     Full-text available via subscription   (Followers: 8)
Advances in Food and Nutrition Research     Full-text available via subscription   (Followers: 51, SJR: 0.674, h-index: 38)
Advances in Fuel Cells     Full-text available via subscription   (Followers: 16)
Advances in Genetics     Full-text available via subscription   (Followers: 15, SJR: 2.558, h-index: 54)
Advances in Genome Biology     Full-text available via subscription   (Followers: 11)
Advances in Geophysics     Full-text available via subscription   (Followers: 6, SJR: 2.325, h-index: 20)
Advances in Heat Transfer     Full-text available via subscription   (Followers: 22, SJR: 0.906, h-index: 24)
Advances in Heterocyclic Chemistry     Full-text available via subscription   (Followers: 9, SJR: 0.497, h-index: 31)
Advances in Human Factors/Ergonomics     Full-text available via subscription   (Followers: 26)
Advances in Imaging and Electron Physics     Full-text available via subscription   (Followers: 2, SJR: 0.396, h-index: 27)
Advances in Immunology     Full-text available via subscription   (Followers: 36, SJR: 4.152, h-index: 85)
Advances in Inorganic Chemistry     Full-text available via subscription   (Followers: 9, SJR: 1.132, h-index: 42)
Advances in Insect Physiology     Full-text available via subscription   (Followers: 3, SJR: 1.274, h-index: 27)
Advances in Integrative Medicine     Hybrid Journal   (Followers: 6)
Advances in Intl. Accounting     Full-text available via subscription   (Followers: 4)
Advances in Life Course Research     Hybrid Journal   (Followers: 8, SJR: 0.764, h-index: 15)
Advances in Lipobiology     Full-text available via subscription   (Followers: 2)
Advances in Magnetic and Optical Resonance     Full-text available via subscription   (Followers: 9)
Advances in Marine Biology     Full-text available via subscription   (Followers: 16, SJR: 1.645, h-index: 45)
Advances in Mathematics     Full-text available via subscription   (Followers: 10, SJR: 3.261, h-index: 65)
Advances in Medical Sciences     Hybrid Journal   (Followers: 6, SJR: 0.489, h-index: 25)
Advances in Medicinal Chemistry     Full-text available via subscription   (Followers: 5)
Advances in Microbial Physiology     Full-text available via subscription   (Followers: 4, SJR: 1.44, h-index: 51)
Advances in Molecular and Cell Biology     Full-text available via subscription   (Followers: 22)
Advances in Molecular and Cellular Endocrinology     Full-text available via subscription   (Followers: 10)
Advances in Molecular Toxicology     Full-text available via subscription   (Followers: 8, SJR: 0.324, h-index: 8)
Advances in Nanoporous Materials     Full-text available via subscription   (Followers: 4)
Advances in Oncobiology     Full-text available via subscription   (Followers: 3)
Advances in Organ Biology     Full-text available via subscription   (Followers: 2)
Advances in Organometallic Chemistry     Full-text available via subscription   (Followers: 15, SJR: 2.885, h-index: 45)
Advances in Parallel Computing     Full-text available via subscription   (Followers: 7, SJR: 0.148, h-index: 11)
Advances in Parasitology     Full-text available via subscription   (Followers: 7, SJR: 2.37, h-index: 73)
Advances in Pediatrics     Full-text available via subscription   (Followers: 24, SJR: 0.4, h-index: 28)
Advances in Pharmaceutical Sciences     Full-text available via subscription   (Followers: 13)
Advances in Pharmacology     Full-text available via subscription   (Followers: 15, SJR: 1.718, h-index: 58)
Advances in Physical Organic Chemistry     Full-text available via subscription   (Followers: 8, SJR: 0.384, h-index: 26)
Advances in Phytomedicine     Full-text available via subscription  
Advances in Planar Lipid Bilayers and Liposomes     Full-text available via subscription   (Followers: 3, SJR: 0.248, h-index: 11)
Advances in Plant Biochemistry and Molecular Biology     Full-text available via subscription   (Followers: 8)
Advances in Plant Pathology     Full-text available via subscription   (Followers: 5)
Advances in Porous Media     Full-text available via subscription   (Followers: 4)
Advances in Protein Chemistry     Full-text available via subscription   (Followers: 17)
Advances in Protein Chemistry and Structural Biology     Full-text available via subscription   (Followers: 20, SJR: 1.5, h-index: 62)
Advances in Psychology     Full-text available via subscription   (Followers: 62)
Advances in Quantum Chemistry     Full-text available via subscription   (Followers: 5, SJR: 0.478, h-index: 32)
Advances in Radiation Oncology     Open Access  
Advances in Small Animal Medicine and Surgery     Hybrid Journal   (Followers: 2, SJR: 0.1, h-index: 2)
Advances in Space Biology and Medicine     Full-text available via subscription   (Followers: 5)
Advances in Space Research     Full-text available via subscription   (Followers: 360, SJR: 0.606, h-index: 65)
Advances in Structural Biology     Full-text available via subscription   (Followers: 8)
Advances in Surgery     Full-text available via subscription   (Followers: 7, SJR: 0.823, h-index: 27)
Advances in the Study of Behavior     Full-text available via subscription   (Followers: 30, SJR: 1.321, h-index: 56)
Advances in Veterinary Medicine     Full-text available via subscription   (Followers: 16)
Advances in Veterinary Science and Comparative Medicine     Full-text available via subscription   (Followers: 13)
Advances in Virus Research     Full-text available via subscription   (Followers: 5, SJR: 1.878, h-index: 68)
Advances in Water Resources     Hybrid Journal   (Followers: 44, SJR: 2.408, h-index: 94)
Aeolian Research     Hybrid Journal   (Followers: 5, SJR: 0.973, h-index: 22)
Aerospace Science and Technology     Hybrid Journal   (Followers: 330, SJR: 0.816, h-index: 49)
AEU - Intl. J. of Electronics and Communications     Hybrid Journal   (Followers: 8, SJR: 0.318, h-index: 36)
African J. of Emergency Medicine     Open Access   (Followers: 5, SJR: 0.344, h-index: 6)
Ageing Research Reviews     Hybrid Journal   (Followers: 8, SJR: 3.289, h-index: 78)
Aggression and Violent Behavior     Hybrid Journal   (Followers: 417, SJR: 1.385, h-index: 72)
Agri Gene     Hybrid Journal  
Agricultural and Forest Meteorology     Hybrid Journal   (Followers: 16, SJR: 2.18, h-index: 116)
Agricultural Systems     Hybrid Journal   (Followers: 30, SJR: 1.275, h-index: 74)
Agricultural Water Management     Hybrid Journal   (Followers: 40, SJR: 1.546, h-index: 79)
Agriculture and Agricultural Science Procedia     Open Access  
Agriculture and Natural Resources     Open Access   (Followers: 2)
Agriculture, Ecosystems & Environment     Hybrid Journal   (Followers: 55, SJR: 1.879, h-index: 120)
Ain Shams Engineering J.     Open Access   (Followers: 5, SJR: 0.434, h-index: 14)
Air Medical J.     Hybrid Journal   (Followers: 5, SJR: 0.234, h-index: 18)
AKCE Intl. J. of Graphs and Combinatorics     Open Access   (SJR: 0.285, h-index: 3)
Alcohol     Hybrid Journal   (Followers: 11, SJR: 0.922, h-index: 66)
Alcoholism and Drug Addiction     Open Access   (Followers: 8)
Alergologia Polska : Polish J. of Allergology     Full-text available via subscription   (Followers: 1)
Alexandria Engineering J.     Open Access   (Followers: 1, SJR: 0.436, h-index: 12)
Alexandria J. of Medicine     Open Access   (Followers: 1)
Algal Research     Partially Free   (Followers: 8, SJR: 2.05, h-index: 20)
Alkaloids: Chemical and Biological Perspectives     Full-text available via subscription   (Followers: 3)
Allergologia et Immunopathologia     Full-text available via subscription   (Followers: 1, SJR: 0.46, h-index: 29)
Allergology Intl.     Open Access   (Followers: 4, SJR: 0.776, h-index: 35)
Alpha Omegan     Full-text available via subscription   (SJR: 0.121, h-index: 9)
ALTER - European J. of Disability Research / Revue Européenne de Recherche sur le Handicap     Full-text available via subscription   (Followers: 9, SJR: 0.158, h-index: 9)
Alzheimer's & Dementia     Hybrid Journal   (Followers: 46, SJR: 4.289, h-index: 64)
Alzheimer's & Dementia: Diagnosis, Assessment & Disease Monitoring     Open Access   (Followers: 4)
Alzheimer's & Dementia: Translational Research & Clinical Interventions     Open Access   (Followers: 4)
Ambulatory Pediatrics     Hybrid Journal   (Followers: 5)
American Heart J.     Hybrid Journal   (Followers: 49, SJR: 3.157, h-index: 153)
American J. of Cardiology     Hybrid Journal   (Followers: 48, SJR: 2.063, h-index: 186)
American J. of Emergency Medicine     Hybrid Journal   (Followers: 40, SJR: 0.574, h-index: 65)
American J. of Geriatric Pharmacotherapy     Full-text available via subscription   (Followers: 9, SJR: 1.091, h-index: 45)
American J. of Geriatric Psychiatry     Hybrid Journal   (Followers: 14, SJR: 1.653, h-index: 93)
American J. of Human Genetics     Hybrid Journal   (Followers: 32, SJR: 8.769, h-index: 256)
American J. of Infection Control     Hybrid Journal   (Followers: 26, SJR: 1.259, h-index: 81)
American J. of Kidney Diseases     Hybrid Journal   (Followers: 32, SJR: 2.313, h-index: 172)
American J. of Medicine     Hybrid Journal   (Followers: 46, SJR: 2.023, h-index: 189)
American J. of Medicine Supplements     Full-text available via subscription   (Followers: 3)
American J. of Obstetrics and Gynecology     Hybrid Journal   (Followers: 200, SJR: 2.255, h-index: 171)
American J. of Ophthalmology     Hybrid Journal   (Followers: 59, SJR: 2.803, h-index: 148)
American J. of Ophthalmology Case Reports     Open Access   (Followers: 6)
American J. of Orthodontics and Dentofacial Orthopedics     Full-text available via subscription   (Followers: 6, SJR: 1.249, h-index: 88)
American J. of Otolaryngology     Hybrid Journal   (Followers: 25, SJR: 0.59, h-index: 45)
American J. of Pathology     Hybrid Journal   (Followers: 27, SJR: 2.653, h-index: 228)
American J. of Preventive Medicine     Hybrid Journal   (Followers: 25, SJR: 2.764, h-index: 154)
American J. of Surgery     Hybrid Journal   (Followers: 35, SJR: 1.286, h-index: 125)
American J. of the Medical Sciences     Hybrid Journal   (Followers: 12, SJR: 0.653, h-index: 70)
Ampersand : An Intl. J. of General and Applied Linguistics     Open Access   (Followers: 6)
Anaerobe     Hybrid Journal   (Followers: 4, SJR: 1.066, h-index: 51)
Anaesthesia & Intensive Care Medicine     Full-text available via subscription   (Followers: 58, SJR: 0.124, h-index: 9)
Anaesthesia Critical Care & Pain Medicine     Full-text available via subscription   (Followers: 12)
Anales de Cirugia Vascular     Full-text available via subscription  
Anales de Pediatría     Full-text available via subscription   (Followers: 2, SJR: 0.209, h-index: 27)
Anales de Pediatría (English Edition)     Full-text available via subscription  
Anales de Pediatría Continuada     Full-text available via subscription   (SJR: 0.104, h-index: 3)
Analytic Methods in Accident Research     Hybrid Journal   (Followers: 4, SJR: 2.577, h-index: 7)
Analytica Chimica Acta     Hybrid Journal   (Followers: 37, SJR: 1.548, h-index: 152)
Analytical Biochemistry     Hybrid Journal   (Followers: 166, SJR: 0.725, h-index: 154)
Analytical Chemistry Research     Open Access   (Followers: 8, SJR: 0.18, h-index: 2)
Analytical Spectroscopy Library     Full-text available via subscription   (Followers: 12)
Anesthésie & Réanimation     Full-text available via subscription   (Followers: 1)
Anesthesiology Clinics     Full-text available via subscription   (Followers: 22, SJR: 0.421, h-index: 40)
Angiología     Full-text available via subscription   (SJR: 0.124, h-index: 9)
Angiologia e Cirurgia Vascular     Open Access  

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Journal Cover American Journal of Ophthalmology
  [SJR: 2.803]   [H-I: 148]   [59 followers]  Follow
    
   Hybrid Journal Hybrid journal (It can contain Open Access articles)
   ISSN (Print) 0002-9394
   Published by Elsevier Homepage  [3049 journals]
  • West Indies Glaucoma Laser Study (WIGLS): 1. 12-Month Efficacy of
           Selective Laser Trabeculoplasty in Afro-Caribbeans With Glaucoma
    • Authors: Tony Realini; Hazel Shillingford-Ricketts; Darra Burt; Goundappa K. Balasubramani
      Abstract: Publication date: December 2017
      Source:American Journal of Ophthalmology, Volume 184
      Author(s): Tony Realini, Hazel Shillingford-Ricketts, Darra Burt, Goundappa K. Balasubramani
      Purpose To characterize the 12-month intraocular pressure (IOP)-lowering efficacy of selective laser trabeculoplasty (SLT) as sole therapy for primary open-angle glaucoma (POAG) in an Afro-Caribbean population. Design Stepped-wedge trial. Methods Subjects in St. Lucia and Dominica with established POAG were randomized to prompt washout of IOP-lowering medications followed by SLT, 3-month delay followed by washout and SLT, or 6-month delay followed by washout and SLT. Baseline IOP was obtained on 2 different days after washout. Bilateral 360-degree SLT was performed in 1 session. Posttreatment assessments took place 1 hour, 1 week, and 3, 6, 9, and 12 months post-SLT. The main outcome measure was SLT success (defined as IOP ≤ target IOP in both eyes) at 12 months. Target IOP was a 20% or greater reduction in IOP from postwashout baseline. Results Overall, 72 patients underwent SLT treatment. Mean IOP at enrollment was 15.4 ± 3.6 mm Hg in right eyes and 15.4 ± 3.6 mm Hg in left eyes, which rose to 21.0 ± 3.3 mm Hg and 20.9 ± 3.0 mm Hg, respectively, after washout. Mean IOP at 3, 6, 9, and 12 months ranged from 12.5 mm Hg to 14.5 mm Hg (29.7% to 39.5%; P < .0001 in each eye at each time point). The 12-month success rate was 78%. Transient photophobia and discomfort were common. Conclusions SLT monotherapy safely provides significant IOP reduction in Afro-Caribbean eyes with POAG. This treatment can play a significant role in preventing glaucoma vision loss and blindness in people of African descent living in resource-limited regions.

      PubDate: 2017-10-18T02:21:47Z
      DOI: 10.1016/j.ajo.2017.09.022
      Issue No: Vol. 184 (2017)
       
  • Differences in Optical Coherence Tomography Assessment of Bruch Membrane
           Opening Compared to Stereoscopic Photography for Estimating Cup-to-Disc
           Ratio
    • Authors: Jean-Claude Mwanza; Linda Y. Huang; Donald L. Budenz; Wei Shi; Gintien Huang; Richard K. Lee
      Abstract: Publication date: December 2017
      Source:American Journal of Ophthalmology, Volume 184
      Author(s): Jean-Claude Mwanza, Linda Y. Huang, Donald L. Budenz, Wei Shi, Gintien Huang, Richard K. Lee
      Purpose To compare the vertical and horizontal cup-to-disc ratio (VCDR, HCDR) by an updated optical coherence tomography (OCT) Bruch membrane opening (BMO) algorithm and stereoscopic optic disc photograph readings by glaucoma specialists. Design Reliability analysis. Methods A total of 195 eyes (116 glaucoma and 79 glaucoma suspect) of 99 patients with stereoscopic photographs and OCT scans of the optic discs taken during the same visit were compared. Optic disc photographs were read by 2 masked glaucoma specialists for VCDR and HCDR estimation. Intraclass correlation coefficient (ICC) and Bland-Altman plots were used to assess the agreement between photograph reading and OCT in estimating CDR. Results OCT images computed significantly larger VCDR and HCDR than photograph reading before and after stratifying eyes based on disc size (P < .001). The difference in CDR estimates between the 2 methods was equal to or greater than 0.2 in 29% and 35% of the eyes for VCDR and HCDR, respectively, with a mean difference of 0.3 in each case. The ICCs between the readers and OCT ranged between 0.50 and 0.63. The size of disagreement in VCDR correlated weakly with cup area in eyes with medium (r2 = 0.10, P = .008) and large (r2 = 0.09, P = .007) discs. Conclusions OCT and photograph reading by clinicians agree poorly in CDR assessment. The difference in VCDR between the 2 methods was depended on cup area in medium and large discs. These differences should be considered when making conclusions regarding CDRs in clinical practice.

      PubDate: 2017-10-18T02:21:47Z
      DOI: 10.1016/j.ajo.2017.09.024
      Issue No: Vol. 184 (2017)
       
  • Elevated Aqueous Cytokine Levels in Eyes With Ocular Surface Diseases
    • Authors: Naohiko Aketa; Takefumi Yamaguchi; Teru Asato; Yukari Yagi-Yaguchi; Terumasa Suzuki; Kazunari Higa; Toshihide Kurihara; Yoshiyuki Satake; Kazuo Tsubota; Jun Shimazaki
      Abstract: Publication date: December 2017
      Source:American Journal of Ophthalmology, Volume 184
      Author(s): Naohiko Aketa, Takefumi Yamaguchi, Teru Asato, Yukari Yagi-Yaguchi, Terumasa Suzuki, Kazunari Higa, Toshihide Kurihara, Yoshiyuki Satake, Kazuo Tsubota, Jun Shimazaki
      Purpose To evaluate cytokine and protein levels in the aqueous humor (AqH) of eyes with ocular surface diseases. Design Prospective consecutive case series. Methods This study includes 14 patients (aged 62.4 ± 13.7 years) with chronic-phase ocular surface diseases (4 with ocular cicatricial pemphigoid, 5 with chemical burns, 2 with a thermal burn, 2 with Stevens-Johnson syndrome, and 1 with exposure keratitis), 14 matched patients without ocular surface disease (controls with corneal scar), and 30 patients who underwent cataract surgery (healthy controls). AqH samples were collected at the beginning of surgery. AqH levels of cytokines (interleukin [IL]-1α, IL-1β, IL-4, IL-6, IL-8, IL-10, IL-12p70, IL-13, IL-17A, monocyte chemotactic protein [MCP]-1, interferon [IFN]-α, IFN-γ, macrophage inflammatory protein [MIP]-1α, MIP-1β, P-selectin, E-selectin, soluble-intercellular adhesion molecule [s-ICAM]-1, tumor necrosis factor [TNF]-α, granulocyte-macrophage colony-stimulating factor [GM-CSF], IFN-γ-induced protein [IP]-10) were measured using multiplex beads immunoassays. Results The levels of IL-6, IL-10, IL-17A, GM-CSF, E-selectin, P-selectin, and s-ICAM in AqH were significantly elevated in eyes with ocular surface diseases (in pg/mL: 1696 ± 804, 4.0 ± 1.0, 24.3 ± 9.8, 26.0 ± 18.3, 5150 ± 1232, 13122 ± 7219, and 7914 ± 2813, respectively), compared to healthy controls (IL-6: 6.36 ± 0.94, P = .001; IL-10: 1.68 ± 0.04, P = .0006; IL-17A: 3.7 ± 0.2, P = .008; GM-CSF: 2.7 ± 0.3, P = .007; E-selectin: 2093 ± 37, P = .0001; P-selectin: 3658 ± 137, P = .0001; sICAM-1: 1397 ± 119, P = .008). The levels of IL-6, IL-17A, E-selectin, and P-selectin in AqH were significantly higher in eyes with ocular surface diseases compared to those with corneal scar (IL-6: 44.1 ± 15.0, P = .0077; IL-17A: 4.1 ± 0.7, P = .034; E-selectin: 2439 ± 302, P = .039; and P-selectin: 5673 ± 1553, P = .017). Conclusions Multiple AqH cytokine levels were elevated in chronic ocular surface diseases.

      PubDate: 2017-10-18T02:21:47Z
      DOI: 10.1016/j.ajo.2017.09.029
      Issue No: Vol. 184 (2017)
       
  • Corneal Higher-order Aberrations and Visual Improvement Following Corneal
           Transplantation in Treating Herpes Simplex Keratitis
    • Authors: Eisuke Shimizu; Takefumi Yamaguchi; Daisuke Tomida; Yukari Yagi-Yaguchi; Yoshiyuki Satake; Kazuo Tsubota; Jun Shimazaki
      Pages: 1 - 10
      Abstract: Publication date: December 2017
      Source:American Journal of Ophthalmology, Volume 184
      Author(s): Eisuke Shimizu, Takefumi Yamaguchi, Daisuke Tomida, Yukari Yagi-Yaguchi, Yoshiyuki Satake, Kazuo Tsubota, Jun Shimazaki
      Purpose To examine corneal higher-order aberrations (HOAs) and visual improvement following corneal transplantation in treating corneal scar caused by herpes simplex keratitis (HSK). Design Retrospective consecutive case series. Methods This study included a total of 52 eyes: 18 eyes of normal subjects, and 34 eyes of consecutive patients with corneal scar owing to HSK who underwent penetrating keratoplasty (PKP, 17 eyes) or deep anterior lamellar keratoplasty (DALK, 17 eyes). HOAs of the anterior, posterior surfaces and the total cornea were analyzed by anterior segment optical coherence tomography. The correlations between corneal HOAs and visual improvement were also analyzed. Results Mean logarithm of the minimal angle of resolution (logMAR) visual acuity significantly improved from 1.40 ± 0.70 to 0.46 ± 0.45 after corneal transplantation (P < .0001). Mean corneal HOAs of the anterior surface significantly decreased after corneal transplantation (PKP: from 1.16 ± 0.59 μm to 0.58 ± 0.35 μm, P = .035, DALK: from 0.94 ± 0.57 μm to 0.37 ± 0.18 μm, P = .004). Visual acuity following corneal transplantation was correlated with the corneal HOAs at 12 months (r = 0.53, P = .01). Visual improvement at 3, 6, and 12 months was positively correlated with preoperative HOAs of the total cornea and posterior surface (all P < .01). Conclusions Preoperative corneal HOAs were associated with the visual improvement in treating corneal scar caused by HSK. Thus, the preoperative assessment of corneal HOAs, especially of the posterior surface, is important in the decision to perform corneal transplantation in eyes with HSK.

      PubDate: 2017-10-18T02:21:47Z
      DOI: 10.1016/j.ajo.2017.09.017
      Issue No: Vol. 184 (2017)
       
  • Optical Coherence Tomography Protocols for Screening of Hydroxychloroquine
           Retinopathy in Asian Patients
    • Authors: Seong Joon Ahn; Jooyoung Joung; Han Woong Lim; Byung Ro Lee
      Pages: 11 - 18
      Abstract: Publication date: December 2017
      Source:American Journal of Ophthalmology, Volume 184
      Author(s): Seong Joon Ahn, Jooyoung Joung, Han Woong Lim, Byung Ro Lee
      Purpose To investigate the distribution of outer retinal changes in hydroxychloroquine (HCQ) retinopathy and explore optical coherence tomography (OCT) protocols to maximize the sensitivity of HCQ retinopathy detection in Asian patients. Design Diagnostic validity assessment. Methods Setting : Institutional. Patient Population : Forty-eight eyes (24 patients) with HCQ retinopathy underwent 6-mm horizontal and vertical line scans and 6 × 6-mm2 volume scans using spectral-domain OCT (SD-OCT), and 9-mm line scans and 6 × 6-mm2 and 12 × 9-mm2 volume scans using swept-source OCT (SS-OCT). Observation Procedures : Distances from the fovea to the defective photoreceptors were measured in the temporal, nasal, superior, and inferior directions from line scan OCT images. The sensitivity of retinopathy detection, indicated by photoreceptor defects, was compared among protocols. Main Outcome Measures : Detection of photoreceptor defects and distances from the fovea to the defects. Results The average minimum distance from the fovea to an area of photoreceptor defects was 1.84 ± 1.26 mm (mean ± standard deviation). The distances were greater than 3 mm horizontally and vertically in 15 (31.3%) and 17 (35.4%) eyes with HCQ retinopathy, respectively, and only wide-field line or volume scans could detect defects in the eyes. The 9-mm line scans detected HCQ retinopathy significantly better than 6-mm scans (P < .001); the sensitivity of the wide volume scan was significantly greater than the standard volume scan (P = .001). The 12 × 9-mm2 volume scan detected retinopathy with the greatest sensitivity (100%). Conclusions Our study recommends a wide-field OCT scan to screen Asian patients taking HCQ medications.

      PubDate: 2017-10-18T02:21:47Z
      DOI: 10.1016/j.ajo.2017.09.025
      Issue No: Vol. 184 (2017)
       
  • The ISNT Rule: How Often Does It Apply to Disc Photographs and Retinal
           Nerve Fiber Layer Measurements in the Normal Population'
    • Authors: Linda Yi-Chieh Poon; David Solá-Del Valle; Angela V. Turalba; Iryna A. Falkenstein; Michael Horsley; Julie H. Kim; Brian J. Song; Hana L. Takusagawa; Kaidi Wang; Teresa C. Chen
      Pages: 19 - 27
      Abstract: Publication date: December 2017
      Source:American Journal of Ophthalmology, Volume 184
      Author(s): Linda Yi-Chieh Poon, David Solá-Del Valle, Angela V. Turalba, Iryna A. Falkenstein, Michael Horsley, Julie H. Kim, Brian J. Song, Hana L. Takusagawa, Kaidi Wang, Teresa C. Chen
      Purpose To determine what percentage of normal eyes follow the ISNT rule, and whether ISNT rule variants may be more generalizable to the normal population. Design Cross-sectional study. Methods Setting : Institutional setting. Study Population : Total of 110 normal subjects. Observation Procedures : Neuroretinal rim assessments from disc photographs and retinal nerve fiber layer (RNFL) thickness measurements from spectral-domain optical coherence tomography. Main Outcome Measures : The percentages of subjects that obeyed the ISNT rule and its variants. Results The ISNT rule is only valid for 37.0% of disc photograph rim assessments and 43.8% of RNFL measurements. Deviation of the nasal sector from the expected ISNT pattern was a major cause for the ISNT rule not being obeyed for both rim and RNFL assessments. Specifically, 10.9% of subjects had wider nasal rims than the inferior rims, 29.4% had wider nasal rims than the superior rims, 14.7% had narrower nasal rims than the temporal rims, and 42.9% had thinner nasal RNFLs compared to the temporal quadrant. Exclusion of the nasal quadrant from the ISNT rule significantly increased the validity of ISNT variant rules, with 70.9% and 76.4% of disc photographs following the IST rule and the IS rule, respectively. Similarly, for RNFL thickness, 70.9% and 71.8% of patients followed the IST and IS rule, respectively. Conclusions The ISNT rule is only valid for about a third of disc photographs and less than half of RNFL measurements in normal patients. ISNT rule variants, such as the IST and IS rule, may be considered, as they are valid in more than 70% of patients.

      PubDate: 2017-10-18T02:21:47Z
      DOI: 10.1016/j.ajo.2017.09.018
      Issue No: Vol. 184 (2017)
       
  • Visual Performance of a Quadrifocal (Trifocal) Intraocular Lens Following
           Removal of the Crystalline Lens
    • Authors: Thomas Kohnen; Michael Herzog; Eva Hemkeppler; Sabrina Schönbrunn; Nina De Lorenzo; Kerstin Petermann; Myriam Böhm
      Pages: 52 - 62
      Abstract: Publication date: December 2017
      Source:American Journal of Ophthalmology, Volume 184
      Author(s): Thomas Kohnen, Michael Herzog, Eva Hemkeppler, Sabrina Schönbrunn, Nina De Lorenzo, Kerstin Petermann, Myriam Böhm
      Purpose To evaluate visual performance after implantation of a quadrifocal intraocular lens (IOL). Methods Setting : Department of Ophthalmology, Goethe University, Frankfurt, Germany. Study Population : Twenty-seven patients (54 eyes) received bilateral implantation of the PanOptix IOL (AcrySof IQ PanOptixTM; Alcon Research, Fort Worth, Texas, USA) pre-enrollment. Exclusion criteria were previous ocular surgeries, corneal astigmatism of >1.5 diopter (D), ocular pathologies, or corneal abnormalities. Intervention or Observational Procedure(s) : Postoperative examination at 3 months including manifest refraction; uncorrected visual acuity (UCVA) and distance-corrected visual acuity (DCVA) in 4 m, 80 cm, 60 cm, and 40 cm slit-lamp examination; defocus testing; contrast sensitivity (CS) under photopic and mesopic conditions; and a questionnaire on subjective quality of vision, optical phenomena, and spectacle independence was performed. Main Outcome Measure(s) : At 3 months postoperatively, UCVA and DCVA in 4 m, 80 cm, 60 cm, and 40 cm (logMAR), defocus curves, CS, and quality-of-vision questionnaire results. Results Mean spherical equivalent was −0.04 ± 0.321 D 3 months postoperatively. Binocular UCVA at distance, intermediate (80 cm, 60 cm), and near was 0.00 ± 0.094 logMAR, 0.09 ± 0.107 logMAR, 0.00 ± 0.111 logMAR, and 0.01 ± 0.087 logMAR, respectively. Binocular defocus curve showed peaks with best visual acuity (VA) at 0.00 D (−0.07 logMAR) and −2.00 D (−0.02 logMAR). Conclusion Visual performance of the PanOptix IOL showed good VA at all distances; particularly good intermediate VA (logMAR > 0.1), with best VA at 60 cm; and high patient satisfaction and spectacle independence 3 months postoperatively.

      PubDate: 2017-10-31T02:58:08Z
      DOI: 10.1016/j.ajo.2017.09.016
      Issue No: Vol. 184 (2017)
       
  • Comparison of Glaucoma Progression Detection by Optical Coherence
           Tomography and Visual Field
    • Authors: Xinbo Zhang; Anna Dastiridou; Brian A. Francis; Ou Tan; Rohit Varma; David S. Greenfield; Joel S. Schuman; David Huang
      Pages: 63 - 74
      Abstract: Publication date: December 2017
      Source:American Journal of Ophthalmology, Volume 184
      Author(s): Xinbo Zhang, Anna Dastiridou, Brian A. Francis, Ou Tan, Rohit Varma, David S. Greenfield, Joel S. Schuman, David Huang
      Purpose To compare longitudinal glaucoma progression detection using optical coherence tomography (OCT) and visual field (VF). Design Validity assessment. Methods We analyzed subjects with more than 4 semi-annual follow-up visits (every 6 months) in the multicenter Advanced Imaging for Glaucoma Study. Fourier-domain optical coherence tomography (OCT) was used to map the thickness of the peripapillary retinal nerve fiber layer (NFL) and ganglion cell complex (GCC). OCT-based progression detection was defined as a significant negative trend for either NFL or GCC. VF progression was reached if either the event or trend analysis reached significance. Results The analysis included 356 glaucoma suspect/preperimetric glaucoma (GS/PPG) eyes and 153 perimetric glaucoma (PG) eyes. Follow-up length was 54.1 ± 16.2 months for GS/PPG eyes and 56.7 ± 16.0 for PG eyes. Progression was detected in 62.1% of PG eyes and 59.8% of GS/PPG eyes by OCT, significantly (P < .001) more than the detection rate of 41.8% and 27.3% by VF. In severity-stratified analysis of PG eyes, OCT had significantly higher detection rate than VF in mild PG (63.1% vs. 38.7%, P < .001), but not in moderate and advanced PG. The rate of NFL thinning slowed dramatically in advanced PG, but GCC thinning rate remained relatively steady and allowed good progression detection even in advanced disease. The Kaplan-Meier time-to-event analyses showed that OCT detected progression earlier than VF in both PG and GS/PPG groups. Conclusions OCT is more sensitive than VF for the detection of progression in early glaucoma. While the utility of NFL declines in advanced glaucoma, GCC remains a sensitive progression detector from early to advanced stages.

      PubDate: 2017-10-24T02:42:41Z
      DOI: 10.1016/j.ajo.2017.09.020
      Issue No: Vol. 184 (2017)
       
  • Preoperative Bevacizumab Administration in Proliferative Diabetic
           Retinopathy Patients Undergoing Vitrectomy: A Randomized and Controlled
           Trial Comparing Interval Variation
    • Authors: Javier Castillo; Isaac Aleman; Sloan W. Rush; Ryan B. Rush
      Pages: 1 - 10
      Abstract: Publication date: November 2017
      Source:American Journal of Ophthalmology, Volume 183
      Author(s): Javier Castillo, Isaac Aleman, Sloan W. Rush, Ryan B. Rush
      Purpose To assess the optimal interval of preoperative intravitreal bevacizumab (IVB) administration in diabetic subjects undergoing pars plana vitrectomy (PPV) for severe manifestations of active proliferative diabetic retinopathy (PDR). Design Randomized clinical trial. Methods One hundred and fifty-six patients with PDR-related complications requiring PPV were prospectively randomized into 1 of 2 treatment groups: Group A received IVB (2.5 mg/0.1 mL) 1–3 days before PPV, while Group B received IVB (2.5 mg/0.1 mL) 5–10 days before PPV. The primary outcome was best-corrected visual acuity (BCVA) at 6 months follow-up. Secondary outcome measures were intraoperative surgery time, intraoperative complications, postoperative complications, and incidence of unplanned PPV at 6 months follow-up. Results One hundred and twenty-five subjects underwent PPV and completed the 6-month follow-up interval. Group B patients had better final BCVA (P = .033) and were less likely to have a postoperative complication (P = .018) when compared to Group A patients. The mean difference in final BCVA between groups was 0.22 logMAR (95% confidence interval: 0.02–0.43, P = .017). Group A was 3.90 (95% confidence interval: 1.08–17.31, P = .046) times more likely to have a loss of 1 or more logMAR lines of final BCVA when compared to Group B. There were no significant differences among the treatment groups with regard to baseline features, intraoperative surgery time, intraoperative complications, and incidence of unplanned PPV during the study interval. Conclusions This randomized clinical trial demonstrated better postoperative outcomes at 6 months when subjects received preoperative IVB 5–10 days before PPV compared to 1–3 days for the treatment of PDR-related complications.

      PubDate: 2017-09-14T02:13:10Z
      DOI: 10.1016/j.ajo.2017.08.013
      Issue No: Vol. 183 (2017)
       
  • Pediatric Corneal Cross-linking: Comparison of Visual and Topographic
           Outcomes Between Conventional and Accelerated Treatment
    • Authors: Philipp B. Baenninger; Lucas M. Bachmann; Ludmilla Wienecke; Michael A. Thiel; Claude Kaufmann
      Pages: 11 - 16
      Abstract: Publication date: November 2017
      Source:American Journal of Ophthalmology, Volume 183
      Author(s): Philipp B. Baenninger, Lucas M. Bachmann, Ludmilla Wienecke, Michael A. Thiel, Claude Kaufmann
      Purpose To compare visual and topographic outcomes 1 year after conventional (C-CXL) vs accelerated corneal cross-linking (A-CXL) in pediatric keratoconus (KC). Design Comparative, retrospective, consecutive case series. Methods Patients with topography-confirmed, progressive KC and a corneal thickness of ≥400 μm at the time of surgery were enrolled. Uncorrected (UCVA) and best phoropter-corrected visual acuity (BCVA) and normal maximum keratometry reading (Kmax) were measured at study entry and at the 12-month follow-up. Treatment failure rate was defined as the percentage of eyes with an increase in Kmax of more than 1.0 diopter during follow-up. The adverse event rate was the percentage of eyes with a loss of ≥2 Snellen lines of BCVA from baseline. This was a single-center analysis of 78 eyes of 58 patients that underwent C-CXL (39 eyes) and A-CXL (39 eyes). No eyes were lost to follow-up after 12 months. Results No significant difference between changes in 12 months after as compared to the time before CXL for UCVA (0.01 log MAR; 95% confidence interval −0.14 to 0.15, P = .944), BCVA (0.05 log MAR; 95% confidence interval −0.05 to 0.15, P = .310), and Kmax (−0.77 diopters; 95% confidence interval −2.20 to 0.65, P = .282) between the C-CXL and A-CXL group were observed. Treatment failure rate was observed in 9 of 39 eyes (23.1%) in C-CXL and in 6 of 39 eyes (15.4%) in A-CXL (P = .389). Adverse events were seen only in 1 eye in the C-CXL group. Conclusions In this retrospective comparison, the accelerated approach was equally as effective as the conventional protocol to treat pediatric keratoconus.

      PubDate: 2017-09-14T02:13:10Z
      DOI: 10.1016/j.ajo.2017.08.015
      Issue No: Vol. 183 (2017)
       
  • Circumferential Trabeculotomy Versus Conventional Angle Surgery: Comparing
           Long-term Surgical Success and Clinical Outcomes in Children With Primary
           Congenital Glaucoma
    • Authors: Rebecca F. Neustein; Allen D. Beck
      Pages: 17 - 24
      Abstract: Publication date: November 2017
      Source:American Journal of Ophthalmology, Volume 183
      Author(s): Rebecca F. Neustein, Allen D. Beck
      Purpose This study compares the long-term efficacy of circumferential trabeculotomy to that of conventional angle surgeries in primary congenital glaucoma (PCG), as judged by glaucoma and visual outcomes. Design Retrospective observational case series. Methods Setting: Emory Eye Center, Atlanta, Georgia. Study Population: This was a single-institution retrospective study involving children with PCG who underwent circumferential trabeculotomy, standard trabeculotomy, or goniotomy with ≥2-year follow-up. Main Outcome Measures: Postoperative success (intraocular pressure [IOP] < 22 mm Hg ± glaucoma medications, without glaucoma progression/additional IOP-lowering surgery), Snellen-equivalent visual acuity (VA), and IOP at last follow-up. Kaplan-Meier method estimated the probability of glaucoma control vs time postoperatively, and values were compared between angle surgery cohorts using Wilcoxon signed rank tests, Mann-Whitney U tests, and Fisher exact tests. Results Included were 58 eyes (33 children) after circumferential trabeculotomy and 42 eyes (27 children) after standard trabeculotomy/goniotomy, with mean follow-up of 7.2 ± 4.0 and 8.2 ± 4.5 years, respectively. Postoperative success at last follow-up in the circumferential vs conventional cohorts was 81% (47 of 58 eyes) vs 31% (13 of 42 eyes) (P < .0001). At last follow-up, the circumferential cohort had better median VA than the conventional cohort (20/30 (interquartile range [IQR] 20/25 to 20/70) vs 20/70 (IQR 20/40 to 20/200), P = .009), required fewer glaucoma medications (0.55 ± 1.2 vs 1.61 ± 1.51, P < .0001), had lower IOP in first operated eye (15.2 ± 3.6 vs 18.2 ± 7.0, P = .048), and had comparable incidence of devastating complications (P = .065). Conclusions In this retrospective study, circumferential trabeculotomy afforded better long-term success and visual outcomes than conventional angle surgery for children with PCG.

      PubDate: 2017-09-19T12:48:47Z
      DOI: 10.1016/j.ajo.2017.08.008
      Issue No: Vol. 183 (2017)
       
  • Performance and Safety of a New Ab Interno Gelatin Stent in Refractory
           Glaucoma at 12 Months
    • Authors: Davinder S. Grover; William J. Flynn; Kent P. Bashford; Richard A. Lewis; Yi-Jing Duh; Rupali S. Nangia; Barbara Niksch
      Pages: 25 - 36
      Abstract: Publication date: November 2017
      Source:American Journal of Ophthalmology, Volume 183
      Author(s): Davinder S. Grover, William J. Flynn, Kent P. Bashford, Richard A. Lewis, Yi-Jing Duh, Rupali S. Nangia, Barbara Niksch
      Purpose To evaluate the intraocular pressure (IOP)-lowering performance and safety of an ab interno gelatin stent (XEN 45 Gel Stent, Allergan plc, Irvine, California, USA), a minimally invasive glaucoma surgery device, in refractory glaucoma. Design Single-arm, open-label, multicenter clinical study. Methods Following mitomycin C pretreatment, the stent was placed ab interno in patients who failed prior filtering/cilioablative procedure or had uncontrolled IOP on maximum-tolerated medical therapy, with medicated IOP ≥20 and ≤35 mm Hg and visual field mean deviation ≤−3 dB. Primary performance outcomes: patients (%) achieving ≥20% IOP reduction from baseline on the same or fewer medications and mean IOP change from baseline at month 12. Procedure-related complications and ocular adverse events (AEs) were assessed. Results Sixty-five patients were implanted (intent-to-treat/safety population). At 12 months, 75.4% (46/61; observed data) reported ≥20% IOP lowering from baseline on the same or fewer medications. Mean IOP change from baseline was −9.1 mm Hg (95% confidence interval [CI]: −10.7, −7.5) (n = 52; observed data) at 12 months, excluding patients with missing data (n = 4) and those requiring a glaucoma-related secondary surgical intervention (n = 9). Mean medication count decreased from 3.5 (baseline) to 1.7 (12 months). No intraoperative complications or unexpected postoperative AEs were reported. Most AEs were mild/moderate; common AEs included needling (without sight-threatening complications), nonpersistent loss of best-corrected visual acuity, and transient hypotony (requiring no surgical intervention). Conclusions The gelatin stent reduced IOP and medication use without raising unexpected safety concerns, offering a minimally invasive surgical option for refractory glaucoma patients.

      PubDate: 2017-09-19T12:48:47Z
      DOI: 10.1016/j.ajo.2017.07.023
      Issue No: Vol. 183 (2017)
       
  • The Association Between Glaucoma, Anxiety, and Depression in a Large
           Population
    • Authors: Xinxin Zhang; Daniel James Olson; Patrick Le; Feng-Chang Lin; David Fleischman; Richard Marc Davis
      Pages: 37 - 41
      Abstract: Publication date: November 2017
      Source:American Journal of Ophthalmology, Volume 183
      Author(s): Xinxin Zhang, Daniel James Olson, Patrick Le, Feng-Chang Lin, David Fleischman, Richard Marc Davis
      Purpose To investigate the association between glaucoma and each of anxiety and depression. Design Retrospective case-control study. Methods Settings : University of North Carolina hospitals and outpatient clinics. Study Population : All patients over the age of 18 years seen between July 1, 2008 and October 1, 2015 were included. Observation Procedure : International Classification of Diseases codes were used to identify cases of glaucoma, as well as anxiety and depression. Outcome Measure : Odds ratios (OR) were calculated for glaucoma and each of anxiety and depression. OR were also calculated for above diagnoses separated by age group and sex. Results A total of 4 439 518 patients were screened, of which 11 234 (0.3%) have glaucoma, 96 527 (2.2%) have anxiety, and 103 476 (2.3%) have depression. The adjusted OR was 10.6 (95% confidence interval [CI] 10.0–11.0) for glaucoma and anxiety and 12.3 (95% CI 11.8–12.9) for glaucoma and depression. The likelihood of having anxiety and depression along with glaucoma did not change with age (P = .088, P = .736). Conclusion There was a statistically significant association between glaucoma and each of anxiety and depression.

      PubDate: 2017-10-31T02:58:08Z
      DOI: 10.1016/j.ajo.2017.07.021
      Issue No: Vol. 183 (2017)
       
  • Trabecular Meshwork Height in Primary Open-Angle Glaucoma Versus Primary
           Angle-Closure Glaucoma
    • Authors: Marisse Masis; Rebecca Chen; Travis Porco; Shan C. Lin
      Pages: 42 - 47
      Abstract: Publication date: November 2017
      Source:American Journal of Ophthalmology, Volume 183
      Author(s): Marisse Masis, Rebecca Chen, Travis Porco, Shan C. Lin
      Purpose To determine if trabecular meshwork (TM) height differs between primary open-angle glaucoma (POAG) and primary angle-closure glaucoma (PACG) eyes. Design Prospective, cross-sectional clinical study. Methods Adult patients were consecutively recruited from glaucoma clinics at the University of California, San Francisco, from January 2012 to July 2015. Images were obtained from spectral-domain optical coherence tomography (Cirrus OCT; Carl Zeiss Meditec, Inc, Dublin, California, USA). Univariate and multivariate linear mixed models comparing TM height and glaucoma type were performed to assess the relationship between TM height and glaucoma subtype. Mixed-effects regression was used to adjust for the use of both eyes in some subjects. Results The study included 260 eyes from 161 subjects, composed of 61 men and 100 women. Mean age was 70 years (SD 11.77). There were 199 eyes (123 patients) in the POAG group and 61 eyes (38 patients) in the PACG group. Mean TM heights in the POAG and PACG groups were 812 ± 13 μm and 732 ± 27 μm, respectively, and the difference was significant in univariate analysis (P = .004) and in multivariate analysis (β = −88.7 [24.05–153.5]; P = .008). Conclusion In this clinic-based population, trabecular meshwork height is shorter in PACG patients compared to POAG patients. This finding may provide insight into the pathophysiology of angle closure and provide assistance in future diagnosis, prevention, and management of the angle-closure spectrum of disorders.

      PubDate: 2017-10-24T02:42:41Z
      DOI: 10.1016/j.ajo.2017.08.018
      Issue No: Vol. 183 (2017)
       
  • Clinical Implications of Direct Immunofluorescence Findings in Patients
           With Ocular Mucous Membrane Pemphigoid
    • Authors: Mary T. Labowsky; Sandra S. Stinnett; Jason Liss; Melissa Daluvoy; Russell P. Hall; Christine Shieh
      Pages: 48 - 55
      Abstract: Publication date: November 2017
      Source:American Journal of Ophthalmology, Volume 183
      Author(s): Mary T. Labowsky, Sandra S. Stinnett, Jason Liss, Melissa Daluvoy, Russell P. Hall, Christine Shieh
      Purpose To examine the clinical implications of positive or negative direct immunofluorescence biopsies (DIF) in patients with clinically typical ocular mucous membrane pemphigoid (MMP). Design Retrospective cohort study. Methods The study population was patients with clinically typical ocular MMP disease with documented DIF results who were followed for at least 1 year at the Duke University multidisciplinary ocular MMP clinic. Data were collected by chart review and included patient demographics, clinical examination findings, and history of autoimmune disease and/or malignancy, as well as topical, systemic, and surgical treatments received. Main outcome measures included MMP Disease Area Index, Foster stages, proportion legally blind, duration of follow-up, and use of systemic immunosuppression and ocular procedures in treatment. Results In multivariable analysis restricted to 55 patients, patients with negative and positive biopsies were similar in the outcome measures; however, positive-biopsy patients were more likely to be treated with systemic immunosuppression and were followed for longer at our clinic. Patients with isolated ocular disease were also more likely to have negative biopsies compared to those who also had extraocular disease. Patients who had conjunctival biopsies were more likely to have a negative direct immunofluorescence result than patients with biopsies from other sites. Conclusions We encourage clinicians and patients to consider treatment with systemic immunosuppression even in the absence of diagnosis confirmation by DIF. Furthermore, this study supports current standard of care to pursue a nonocular biopsy of normal-appearing, perilesional skin or oral mucosa when possible.

      PubDate: 2017-09-26T13:07:19Z
      DOI: 10.1016/j.ajo.2017.08.009
      Issue No: Vol. 183 (2017)
       
  • The Effect of Chronic Pulmonary Disease and Mechanical Ventilation on
           Corneal Donor Endothelial Cell Density and Transplant Suitability
    • Authors: Jordan A. Margo; Martha F. Whiting; Clayton H. Brown; Caroline K. Hoover; Wuqaas M. Munir
      Pages: 65 - 70
      Abstract: Publication date: November 2017
      Source:American Journal of Ophthalmology, Volume 183
      Author(s): Jordan A. Margo, Martha F. Whiting, Clayton H. Brown, Caroline K. Hoover, Wuqaas M. Munir
      Purpose To determine how chronic obstructive pulmonary disease (COPD) and mechanical ventilation time affect corneal donor endothelial cell density (ECD) and transplant suitability. Design Retrospective cohort study. Methods Setting : Institutional. Study Population : Total of 39 679 cornea donor eyes from SightLife Eye Bank between 2012 and 2016. Demographics, death-to-preservation time, ECD, lens status, medical history, time on mechanical ventilation, and suitability for transplantation were included. Main Outcome Measures : ECD and transplant suitability. Results Mean ECD was 2733 cells/mm2. Mean age was 59 years. COPD affected 34.2% of donors. Mechanical ventilation was required in 35% of donors. Mean ventilation time was 1.3 days. After controlling for covariates, COPD was not found to be associated with poor transplant suitability (P = .22). Ventilation >7 days was associated with poor transplant suitability (P = .04). Donors with COPD and donors who were mechanically ventilated exhibited lower cell counts (P < .001, P < .01, respectively). Longer ventilation led to reduced endothelial cell density: ventilation time >7 days (−46.5 cells/mm2, P < .001) and >30 days (−101.4 cells/mm2, P = .02). Limitations of the study included the retrospective nature, dataset obtained from a single eye bank, and medical history documentation completed by eye bank technicians. Conclusions A high proportion of cornea donors have respiratory disease prior to donation. Ventilation time >7 days affected transplant suitability but the presence of COPD did not. Donors with COPD and donors who were mechanically ventilated had reduced cell counts. Longer ventilation times lead to increased cell loss. The presence of respiratory disease may affect tissue oxygenation and endothelial cell health.

      PubDate: 2017-10-24T02:42:41Z
      DOI: 10.1016/j.ajo.2017.08.023
      Issue No: Vol. 183 (2017)
       
  • Optical Coherence Tomography Angiography and Ultra-widefield Fluorescein
           Angiography for Early Detection of Adolescent Sickle Retinopathy
    • Authors: Daniel A. Pahl; Nancy S. Green; Monica Bhatia; Margaret T. Lee; Jonathan S. Chang; Maureen Licursi; Courtney Briamonte; Elana Smilow; Royce W.S. Chen
      Pages: 91 - 98
      Abstract: Publication date: November 2017
      Source:American Journal of Ophthalmology, Volume 183
      Author(s): Daniel A. Pahl, Nancy S. Green, Monica Bhatia, Margaret T. Lee, Jonathan S. Chang, Maureen Licursi, Courtney Briamonte, Elana Smilow, Royce W.S. Chen
      Purpose Based on standard screening techniques, sickle retinopathy reportedly occurs in 10% of adolescents with sickle cell disease (SCD). We performed a prospective, observational clinical study to determine if ultra-widefield fluorescein angiography (UWFA), spectral-domain optical coherence tomography (SD-OCT), and optical coherence tomography angiography (OCT-A) detect more-frequent retinopathy in adolescents with SCD. Design Cross-sectional study. Methods Setting : Institutional. Subjects : Sixteen adolescents with SCD, aged 10–19 years (mean age 14.9 years), and 5 age-equivalent controls (mean age 17.4 years). Observation Procedures : Examinations including acuity, standard slit-lamp biomicroscopy, UWFA, SD-OCT, and OCT-A were performed. Main Outcome Measures : Sickle retinopathy defined by biomicroscopic changes, Goldberg stages I-V, Penman scale, flow void on OCT-A, or macular thinning on SD-OCT. Results While 22 of 32 SCD eyes (68.8%) had retinopathy on biomicroscopy, by UWFA 4 of 24 (16.7%) SCD eyes had peripheral arterial occlusion (Goldberg I), and 20 of 24 eyes (83.3%) had peripheral arteriovenous anastomoses (Goldberg II) in addition. No patients had Goldberg stages III-V. By SD-OCT and OCT-A, thinning of the macula and flow voids in both the superficial and deep retinal capillary plexus were found in 6 of 30 (20%) eyes. Conclusions All 24 eyes with adequate UWFA studies demonstrated sickle retinopathy. SD-OCT and OCT-A, which have not been previously reported in the adolescent population, detected abnormal macular thinning and flow abnormalities undetected by biomicroscopy. These findings suggest that pediatric sickle retinopathy may be more prevalent than previously suspected. If these findings are confirmed with larger cross-sectional and prospective analyses, these approaches may enhance early screening for sickle retinopathy.

      PubDate: 2017-09-26T13:07:19Z
      DOI: 10.1016/j.ajo.2017.08.010
      Issue No: Vol. 183 (2017)
       
  • Is Corneal Arcus Independently Associated With Incident Cardiovascular
           Disease in Asians'
    • Authors: Mark Yu Zheng Wong; Ryan Eyn Kidd Man; Preeti Gupta; Sing Hui Lim; Blanche Lim; Yih-Chung Tham; Charumathi Sabanayagam; Tien Yin Wong; Ching-Yu Cheng; Ecosse Luc Lamoureux
      Pages: 99 - 106
      Abstract: Publication date: November 2017
      Source:American Journal of Ophthalmology, Volume 183
      Author(s): Mark Yu Zheng Wong, Ryan Eyn Kidd Man, Preeti Gupta, Sing Hui Lim, Blanche Lim, Yih-Chung Tham, Charumathi Sabanayagam, Tien Yin Wong, Ching-Yu Cheng, Ecosse Luc Lamoureux
      Purpose To examine the longitudinal relationship between baseline corneal arcus (CA) and incident cardiovascular disease (CVD) in ethnic Indian and Malay adults in Singapore. Design Population-based cohort study. Methods Indian and Malay adults aged 40–80 years were recruited for baseline and 6-year follow-up visits between 2004–2009 and 2010–2015, respectively (follow-up response rate 73.9%). CA was assessed by ophthalmologists using slit-lamp biomicroscopy. The main outcome was self-reported incident CVD, defined as new myocardial infarction, angina pectoris, or stroke, which developed between baseline and follow-up. Multivariable logistic regression models assessed independent associations between baseline CA and incident CVD, adjusting for traditional CVD risk factors including age, sex, serum cholesterol, hypertension, diabetes, and smoking. We further conducted sex-stratified analyses to identify possible effect modifications. Results Of the total 3637 participants (overall mean [SD] age: 56 [9] years, 46% male) with available follow-up data, without history of CVD at baseline, 208 (5.7%) incident CVD cases were reported. Participants with CA were more likely to have incident CVD (7.5%) than those without (4.9%). After controlling for traditional CVD risk factors, CA was independently associated with incident CVD (odds ratio [95% confidence interval]: 1.52 [1.07–2.16]) in adjusted models. In sex-stratified models, associations between CA and incident CVD were seen in men (1.73 [1.12–2.67]) and not in women (1.05 [0.56–1.97]). Conclusions CA is associated with incident CVD, independent of serum lipids and traditional CVD risk factors, in ethnic Malay and Indian men. Our finding suggests that CA is an additional observable indicator of CVD in men.

      PubDate: 2017-10-24T02:42:41Z
      DOI: 10.1016/j.ajo.2017.09.002
      Issue No: Vol. 183 (2017)
       
  • The Effect of Pulsing on Transverse Ultrasound Efficiency and Chatter
    • Authors: Alex J. Wright; Austin D. Bohner; Ashlie A. Bernhisel; Brian Zaugg; William R. Barlow; Jeff H. Pettey; Randall J. Olson
      Pages: 107 - 110
      Abstract: Publication date: November 2017
      Source:American Journal of Ophthalmology, Volume 183
      Author(s): Alex J. Wright, Austin D. Bohner, Ashlie A. Bernhisel, Brian Zaugg, William R. Barlow, Jeff H. Pettey, Randall J. Olson
      Purpose To evaluate the effects of micropulse, long pulse, and continuous ultrasound on transverse ultrasound using Abbott Medical Optics' (AMO) WhiteStar Signature Pro with the Ellips FX handpiece. Design In vitro laboratory study. Methods This study was conducted at the John A. Moran Eye Center Laboratory, University of Utah, Salt Lake City, Utah, USA. Porcine lenses were hardened in formalin for 2 hours and equilibrated in basic salt solution (BSS) over a 24-hour period. The lenses were then cubed in 2.0 × 2.0-mm pieces. These pieces were stored in BSS until the time of experimentation. The AMO WhiteStar Signature Pro machine (Abbott Medical Optics) with the Ellips FX handpiece and a 0.9-mm bent Dewey tip with a 30-degree bevel (Microsurgical Technology Inc) were used for phacoemulsification. Three runs of 20 lenses each were performed, measuring efficiency and chatter. Transverse ultrasound varied in the 3 runs and included continuous, 6 ms on/off micropulse, and 50 ms on/off long pulse. Results Micropulse was more efficient than long pulse by 43% (P = .00003) and continuous by 42% (P = .000387). There were also less chatter events with micropulse than with long-pulse and continuous ultrasound. However, this difference did not reach significance. Conclusion The 6 ms on and 6 ms off micropulse transverse 3-dimensional ultrasound is more efficient and produces fewer chatter events than both long-pulse and continuous ultrasound.

      PubDate: 2017-10-02T13:40:01Z
      DOI: 10.1016/j.ajo.2017.08.012
      Issue No: Vol. 183 (2017)
       
  • Residual Angle Closure One Year After Laser Peripheral Iridotomy in
           Primary Angle Closure Suspects
    • Authors: Mani Baskaran; Elizabeth Yang; Sameer Trikha; Rajesh S. Kumar; Hon Tym Wong; Mingguang He; Paul T.K. Chew; Paul J. Foster; David Friedman; Tin Aung
      Pages: 111 - 117
      Abstract: Publication date: November 2017
      Source:American Journal of Ophthalmology, Volume 183
      Author(s): Mani Baskaran, Elizabeth Yang, Sameer Trikha, Rajesh S. Kumar, Hon Tym Wong, Mingguang He, Paul T.K. Chew, Paul J. Foster, David Friedman, Tin Aung
      Purpose To determine the incidence and baseline clinical and anterior segment optical coherence tomography (AS-OCT) predictors associated with residual angle closure as assessed by gonioscopy 1 year after laser peripheral iridotomy (LPI) in primary angle closure suspects (PACS). Design Subanalysis of randomized controlled trial data. Methods AS-OCT images from 181 PACS subjects ≥50 years of age were analyzed using customized software before and 1 year after LPI. Other parameters assessed were intraocular pressure (IOP) and axial length (Axl). Residual angle closure was defined as the inability to see the posterior trabecular meshwork for at least 2 quadrants on gonioscopy after LPI. Multivariate regression analysis determined the baseline predictors of residual angle closure 1 year after LPI. Results The mean age of participants was 62.4 (standard deviation 9.9) years. The majority were female (137, 75.7%) and Chinese (174, 96.1%). At 1 year post LPI, 148 (81.8%) subjects had gonioscopic residual angle closure. Univariate analysis showed that baseline Axl, anterior chamber area, anterior chamber volume, angle opening distance at 750 μm from the scleral spur, and angle recess area were smaller while baseline lens vault and iris curvature were larger in residual angle closure subjects (all P < .05). Multivariate analysis revealed that baseline iris volume (B = −0.08, P = .035) and baseline IOP (B = 0.23, P = .032) were predictors for residual angle closure. Conclusions One year after LPI, >80% of PACS had gonioscopic residual angle closure. Greater baseline iris volume and higher IOP at baseline are independent risk factors for residual gonioscopic angle closure.

      PubDate: 2017-10-31T02:58:08Z
      DOI: 10.1016/j.ajo.2017.08.016
      Issue No: Vol. 183 (2017)
       
  • Factors Associated With Zonular Instability During Cataract Surgery in
           Eyes With Acute Angle Closure Attack
    • Authors: Junki Kwon; Kyung Rim Sung
      Pages: 118 - 124
      Abstract: Publication date: November 2017
      Source:American Journal of Ophthalmology, Volume 183
      Author(s): Junki Kwon, Kyung Rim Sung
      Purpose To compare the demographics and ocular characteristics, including anterior segment optical coherence tomography images and zonular instability, in eyes with a history of acute angle closure (AAC) attack and subsequent cataract surgery. Design Retrospective case-control study. Methods A total of 68 eyes of 56 patients with a history of AAC attack who underwent cataract surgery were enrolled. Fourteen eyes were assigned to the zonular instability (+) group and 54 were assigned to the zonular instability (−) group based on the presence of zonular instability during cataract surgery. The peak intraocular pressure, preoperative spherical equivalent (SE), axial length (AL), anterior chamber depth (ACD), and lens vault (LV) were measured and compared between 2 groups. Intereye (intraindividual) comparison was also performed. Factors associated with zonular instability were assessed. Results In the zonular instability (+) group, 9 eyes were from male and 5 from female participants. Eyes in the zonular instability (+) group showed less hyperopic SE values, longer AL, shallower ACD, and higher LV, as compared with those in the zonular instability (−) group (all P ≤ .001). Moreover, eyes in the zonular instability (+) group had less hyperopic SE, shallower ACD, and higher LV than their fellow eyes. Less hyperopic SE, longer AL, and higher LV were significantly associated with zonular instability on multivariate logistic regression analysis. Conclusions Clinicians should consider the possibility of zonular instability during cataract surgery for eyes with less hyperopic SE, longer AL, and higher LV among those with a history of AAC attack.

      PubDate: 2017-10-31T02:58:08Z
      DOI: 10.1016/j.ajo.2017.09.003
      Issue No: Vol. 183 (2017)
       
  • A Randomized Controlled Trial Comparing Outcomes of Cataract Surgery in
           Nanophthalmos With and Without Prophylactic Sclerostomy
    • Authors: Sharmila Rajendrababu; Naresh Babu; Sapna Sinha; Vijayakumar Balakrishnan; Ashok Vardhan; George Varghese Puthuran; Pradeep Y. Ramulu
      Pages: 125 - 133
      Abstract: Publication date: November 2017
      Source:American Journal of Ophthalmology, Volume 183
      Author(s): Sharmila Rajendrababu, Naresh Babu, Sapna Sinha, Vijayakumar Balakrishnan, Ashok Vardhan, George Varghese Puthuran, Pradeep Y. Ramulu
      Purpose To prospectively evaluate visual outcomes and complications during and after cataract surgery with or without prophylactic sclerostomy in nanophthalmic eyes with visually significant cataract. Study Design Randomized controlled trial. Methods Sixty nanophthalmic eyes of 60 patients with visually significant cataract were randomly assigned to cataract surgery alone (control group, n = 31) or cataract surgery with concomitant prophylactic sclerostomy (sclerostomy group, n = 29). Surgery was performed using phacoemulsification or manual small-incision cataract surgery (SICS) based on the LOCS III grading score. Group differences in intraoperative and postoperative complications were analyzed and risk factors assessed. Results Fewer complications were noted in eyes receiving sclerostomy (5/29, 17.2%) as compared to control group eyes (12/31, 38.7%), though differences were marginally significant (P = .065). Four control group, but no sclerostomy group, eyes developed postoperative uveal effusions (P = .04). In multivariable models, sclerostomy decreased the odds of an intraoperative or postoperative complication by 80% (odds ratio [OR] = 0.2, 95% confidence interval [CI] = 0.04–0.92, P = .039); SICS was associated with a significantly higher risk of complications as compared to phacoemulsification (OR = 5.95, 95% CI = 1.49–23.73, P = .012), while high preoperative intraocular pressure (OR = 4.54, 95% CI = 0.99–20.9, P = .052) and greater lens thickness (OR = 3.38, 95% CI = 0.88–12.91, P = .075) demonstrated a marginally significant association. Conclusions Cataract surgery in eyes with nanophthalmos is associated with a high risk for vision-threatening complications. Performing a simultaneous prophylactic sclerostomy with cataract surgery reduces complication rates, particularly uveal effusions. Cataract surgery at earlier stages by phacoemulsification may be more beneficial than undergoing manual SICS.

      PubDate: 2017-10-31T02:58:08Z
      DOI: 10.1016/j.ajo.2017.09.008
      Issue No: Vol. 183 (2017)
       
  • Peri-dome Choroidal Deepening in Highly Myopic Eyes With Dome-Shaped
           Maculas
    • Authors: Kyoko Ohno-Matsui; Yuxin Fang; Kengo Uramoto; Kosei Shinohara; Tae Yokoi; Tomoka Ishida; Jost B. Jonas
      Pages: 134 - 140
      Abstract: Publication date: November 2017
      Source:American Journal of Ophthalmology, Volume 183
      Author(s): Kyoko Ohno-Matsui, Yuxin Fang, Kengo Uramoto, Kosei Shinohara, Tae Yokoi, Tomoka Ishida, Jost B. Jonas
      Purpose To determine characteristics of peri-dome choroidal deepening (PDCD) surrounding dome-shaped maculas (DSMs) in highly myopic eyes. Design Observational case series. Methods Applying swept-source optical coherence tomography, we examined the posterior pole of highly myopic eyes with DSMs. Results The study included 91 highly myopic eyes (67 patients; mean age: 60.0 ± 15.1 years; mean axial length: 30.0 ± 7.4 mm) with a mean dome height of the DSM of 232 ± 132 μm. PDCDs were detected in 53 (58%) eyes. Subfoveal choroidal thickness was significantly thinner in eyes with vs without PDCDs (35 ± 29 μm vs 62 ± 48 μm; P = .016), while both groups did not vary significantly (all P ≥ .25) in age, axial length, and dome height. In contrast to peripapillary intrachoroidal cavitations (ICCs), PDCDs consisted of a widened choroid without large low-reflective suprachoroidal spaces. Unlike peripapillary ICCs or macular ICCs, PDCDs were not associated with caving of the overlying retina or backward bowing of the sclera. In the region of the PDCDs, the Bruch membrane (BM) was shorter than the inner scleral surface. Defects of the BM overlying the PDCDs were detected in 20 (38%) eyes. Conclusions PDCDs were common findings in highly myopic eyes with DSMs. PDCDs may be associated with a dome-induced inward push of the BM at the top of the DSM, leading to a compression of the subfoveal choroid and, owing to an increased strain of the BM on the dome's slopes, to a relative detachment of BM in the peri-dome region.

      PubDate: 2017-10-31T02:58:08Z
      DOI: 10.1016/j.ajo.2017.09.009
      Issue No: Vol. 183 (2017)
       
  • Outcomes of Ahmed Glaucoma Valve Revision in Pediatric Glaucoma
    • Authors: Ahmed Mansour Al-Omairi; Aliah H. Al Ameri; Sami Al-Shahwan; Arif O. Khan; Ibrahim Al-Jadaan; Ahmed Mousa; Deepak P. Edward
      Pages: 141 - 146
      Abstract: Publication date: November 2017
      Source:American Journal of Ophthalmology, Volume 183
      Author(s): Ahmed Mansour Al-Omairi, Aliah H. Al Ameri, Sami Al-Shahwan, Arif O. Khan, Ibrahim Al-Jadaan, Ahmed Mousa, Deepak P. Edward
      Purpose Encapsulation of the Ahmed glaucoma valve (AGV) plate is a common cause for postoperative elevation of intraocular pressure, especially in children. Many reports have described the outcomes of AGV revision in adults. However, the outcomes of AGV revision in children are poorly documented. The aim of this study was to determine the outcomes of AGV revision in children. Design Retrospective cross-sectional study. Methods A retrospective chart review of patients less than 15 years of age who underwent AGV revision with a minimum postoperative follow-up of 6 months was conducted. Outcome measures included reduction in intraocular pressure from baseline, survival analysis, and reduction in the number of antiglaucoma medications. Postoperative complications were also noted. Complete success was defined as an IOP of 21 mm Hg or less without medications, while qualified success was defined as having an IOP of 21 mm Hg or less with medications. Results A total of 44 eyes met the inclusion criteria. Primary congenital glaucoma was present in 39 eyes (88.6%), aphakic glaucoma in 4 eyes (9.1%), and Peters anomaly–associated glaucoma in 1 eye (2.3%). The mean number of previous surgeries was 1.4, and the mean age was 6.7 years (range, 1.9-13 years) with a median follow-up of 12 months (range, 6-24 months). The IOP was reduced from a preoperative mean of 30.4 (± 10.3) to 24.9 (± 10.6) mm Hg at 6 months postoperatively. Kaplan-Meier analysis showed that the complete success rate at 1 month was 100% followed by a rapid decline at 6 months to 38.6%, 27.7% at 1 year, and 5.5% at 2 years. Qualified success rate was 100% at 1 month followed by a 6-month and 1-year survival rate of approximately 50% and a 2-year survival rate of approximately 16%. The median survival time was 14 months. No specific risk factors for failure were identified. Visual acuity remained unchanged following revision. The most common complication was recurrence of encapsulation with elevated IOP (15.9%). Other complications included hyphema (n = 3; 6.8%), endophthalmitis (n = 1; 2.3%), wound leak (n = 1; 2.3%), and choroidal detachment (n = 2; 4.5%). Conclusion Although the short-term success rate of AGV revision in children is high, with longer follow-up the success rate decreases significantly.

      PubDate: 2017-10-31T02:58:08Z
      DOI: 10.1016/j.ajo.2017.09.015
      Issue No: Vol. 183 (2017)
       
  • Assessment of Optical Coherence Tomography Color Probability Codes in
           Myopic Glaucoma Eyes After Applying a Myopic Normative Database
    • Authors: Bo Ram Seol; Dong Myung Kim; Ki Ho Park; Jin Wook Jeoung
      Pages: 147 - 155
      Abstract: Publication date: November 2017
      Source:American Journal of Ophthalmology, Volume 183
      Author(s): Bo Ram Seol, Dong Myung Kim, Ki Ho Park, Jin Wook Jeoung
      Purpose To evaluate the optical coherence tomography (OCT) color probability codes based on a myopic normative database and to investigate whether the implementation of the myopic normative database can improve the OCT diagnostic ability in myopic glaucoma. Design Comparative validity study. Methods In this study, 305 eyes (154 myopic healthy eyes and 151 myopic glaucoma eyes) were included. A myopic normative database was obtained based on myopic healthy eyes. We evaluated the agreement between OCT color probability codes after applying the built-in and myopic normative databases, respectively. Another 120 eyes (60 myopic healthy eyes and 60 myopic glaucoma eyes) were included and the diagnostic performance of OCT color codes using a myopic normative database was investigated. Results The mean weighted kappa (Kw) coefficients for quadrant retinal nerve fiber layer (RNFL) thickness, clock-hour RNFL thickness, and ganglion cell–inner plexiform layer (GCIPL) thickness were 0.636, 0.627, and 0.564, respectively. The myopic normative database showed a higher specificity than did the built-in normative database in quadrant RNFL thickness, clock-hour RNFL thickness, and GCIPL thickness (P < .001, P < .001, and P < .001, respectively). The receiver operating characteristic curve values increased when using the myopic normative database in quadrant RNFL thickness, clock-hour RNFL thickness, and GCIPL thickness (P = .011, P = .004, P < .001, respectively). Conclusion The diagnostic ability of OCT color codes for detection of myopic glaucoma significantly improved after application of the myopic normative database. The implementation of a myopic normative database is needed to allow more precise interpretation of OCT color probability codes when used in myopic eyes.

      PubDate: 2017-10-31T02:58:08Z
      DOI: 10.1016/j.ajo.2017.09.010
      Issue No: Vol. 183 (2017)
       
  • Increased Frequency of Topical Steroids Provides Benefits in Patients With
           Recalcitrant Postsurgical Postsurgical Macular Edema
    • Authors: Punita Kumari Sodhi
      First page: 163
      Abstract: Publication date: November 2017
      Source:American Journal of Ophthalmology, Volume 183
      Author(s): Punita Kumari Sodhi


      PubDate: 2017-10-31T02:58:08Z
      DOI: 10.1016/j.ajo.2017.09.005
      Issue No: Vol. 183 (2017)
       
  • Reduced Free Communication of the Subarachnoid Space Within the Optic
           Canal in the Human
    • Authors: Hanspeter E. Killer; Achmed Pircher
      Pages: 164 - 165
      Abstract: Publication date: November 2017
      Source:American Journal of Ophthalmology, Volume 183
      Author(s): Hanspeter E. Killer, Achmed Pircher


      PubDate: 2017-10-31T02:58:08Z
      DOI: 10.1016/j.ajo.2017.09.011
      Issue No: Vol. 183 (2017)
       
  • Clinical and Radiological Evaluation of Periocular Infantile Hemangioma
           Treated With Oral Propranolol: A Case Series
    • Authors: Maria Antonieta Ginguerra; Osmar Saito; José Byron V.D. Fernandes; Deborah S. Castro; Suzana Matayoshi
      Abstract: Publication date: Available online 3 November 2017
      Source:American Journal of Ophthalmology
      Author(s): Maria Antonieta Ginguerra, Osmar Saito, José Byron V.D. Fernandes, Deborah S. Castro, Suzana Matayoshi
      Purpose To evaluate the efficacy of propranolol (3 mg/kg/day) in the treatment of periocular infantile hemangioma (IH) based on clinical and radiological findings. Design Prospective interventional case series. Methods Study of previously untreated infants with IH conducted at the ophthalmology outpatient service of HC-FMUSP (Brazil). The patients were submitted to a complete ophthalmologic examination, gray-scale and Doppler ultrasonography, and nuclear magnetic resonance imaging. Lesion regression was evaluated clinically and radiologically during follow-up. The sample consisted of potentially amblyogenic and disfiguring lesions. The dose was increased at weekly intervals, from 0.5 mg to 3 mg/kg/day. The age at onset of treatment was 2–28 months. Follow-up lasted up to 48 months. Results Nine infants with periocular IH were treated with propranolol (oral) for 2–12 months (mean: 7.1 months). Clinical regression (attenuation of color and reduction in size) was observed in 88% during the first days of treatment. Partial recurrence was observed during follow-up in a patient treated for 6 months. On Doppler ultrasonography, during the first 6 months of treatment lesion volume and vascular density decreased while the arterial resistivity index (RI) increased, followed by a decline. Conclusion Propranolol at 3 mg/kg/day was clinically and radiologically efficacious against deep IH in the proliferative stage, with no recurrence in patients treated for 12 months. RI might help determine when treatment can be safely interrupted.

      PubDate: 2017-11-18T08:50:02Z
      DOI: 10.1016/j.ajo.2017.10.021
       
  • Scleral Lenses Reduce the Need for Corneal Transplants in Severe
           Keratoconus
    • Authors: Carina Koppen; Elke O. Kreps; Lieselotte Anthonissen; Maarten Van Hoey; Sorcha Ni Dhubhghaill; Louise Vermeulen
      Abstract: Publication date: Available online 3 November 2017
      Source:American Journal of Ophthalmology
      Author(s): Carina Koppen, Elke O. Kreps, Lieselotte Anthonissen, Maarten Van Hoey, Sorcha Ni Dhubhghaill, Louise Vermeulen
      Purpose To investigate the success and failure rates of scleral lens correction in severe keratoconus. Design Retrospective case series. Methods Study population comprised patients with keratoconus who attended the keratoconus clinic at the Antwerp University Hospital, Belgium, between January 1, 2010, and December 31, 2014. The included eyes had maximal keratometry values ≥ 70 diopters, as measured using the sagittal curvature map that was obtained by Scheimpflug tomography. The exclusion criteria included amblyopia, mental retardation, and concomitant ocular disease that limited their visual potential. Results Scleral lens fitting was proposed for the 75 eyes included in the study. Eight eyes underwent transplant surgery because of insufficient visual acuity with the lenses, lens intolerance, and issues with handling the lenses. Twelve eyes did not have lenses fitted because of good visual acuity in the other eye or a contraindication for lens wear. Three eyes were successfully fitted with corneal or hybrid lens wear. Scleral lenses were prescribed in 51 of 75 eyes. The mean gain in visual acuity (lens vs spectacle-corrected visual acuity) was 0.54 ± 0.18 (decimal fraction, Snellen eye chart). Seven eyes were lost to follow-up, 4 eyes abandoned wearing the scleral lens because of an inability to handle the lenses, and 40 eyes wore the lenses at their last follow-up visit, with a mean follow-up interval of 30.15 ± 12.83 months. Conclusions Forty of the 51 eyes with severe keratoconus that would otherwise have undergone transplant surgery were successfully treated with long-term scleral lens wear. In this way, the indication for keratoplasty was more than halved in our keratoconus population.

      PubDate: 2017-11-18T08:50:02Z
      DOI: 10.1016/j.ajo.2017.10.022
       
  • Longitudinal Change in Central Corneal Thickness in the Tema Eye Survey
    • Authors: Jean-Claude Mwanza; Samantha E. Tulenko; Donald L. Budenz; Elizabeth Mathenge; Leon H. Herndon; Hanna Y. Kim; Alyson Hall; Graham Hay-Smith; Alexander Spratt; Keith Barton
      Abstract: Publication date: Available online 12 November 2017
      Source:American Journal of Ophthalmology
      Author(s): Jean-Claude Mwanza, Samantha E. Tulenko, Donald L. Budenz, Elizabeth Mathenge, Leon H. Herndon, Hanna Y. Kim, Alyson Hall, Graham Hay-Smith, Alexander Spratt, Keith Barton
      Purpose To determine the change and rate of change in central corneal thickness (CCT) and their determinants. Design Longitudinal observational population-based study. Methods 758 normal and 58 glaucomatous subjects underwent complete eye examination, with CCT measurements at two separate visits. Change and rate of change in CCT were determined. Univariate and multivariate linear regression analyses were performed to determine the factors associated with change and rate of change. Results The mean follow-up duration was 8.4 ± 0.7 years. The overall change was -8.9 ± 16.7 μm in OD and -9.8 ± 16.2 μm in OS, both P < .0001. Changes in glaucomatous and normal subjects were -14.1 ± 2.2 μm vs. -8.6 ± 0.6 μm in OD (P = .02) and -14.5 ± 2.2 μm vs. -9.5 ± 0.6 μm in OS (P = .03), respectively. The overall rate of thinning was -1.1 μm/year (OD) and -1.2 μm/year (OS). Rates in glaucomatous and normal were -1.7 ± 0.3 vs. -1.0 ± 0.1 μm/year in OD (P = .02) and -1.7 ± 0.3 vs. -1.1 ± 0.1 μm/year in OS (P = .03), respectively. Change and rate of change were associated with baseline CCT (ß = -0.1 to -0.09 and -0.011, respectively, all P < .001) and glaucoma (ß = -6.8 to -5.6, P ≤ .009 and -0.75 to -0.69, P ≤ .007, respectively). Conclusion CCT decreased significantly over time. The change and rate of change were greater in glaucomatous than normal eyes, and greater than described in cross-sectional studies.

      PubDate: 2017-11-14T08:35:03Z
      DOI: 10.1016/j.ajo.2017.11.002
       
  • Moving from Clinic to Home: What the Future Holds for Ophthalmic
           Telemedicine
    • Authors: Nancy M. Holekamp
      Abstract: Publication date: Available online 11 November 2017
      Source:American Journal of Ophthalmology
      Author(s): Nancy M. Holekamp
      PURPOSE To describe the expanding role of telemedicine in healthcare, the key criteria required for a successful device and program implementation, and the current and future role of home monitoring in ophthalmology. DESIGN Expert perspective METHODS Analysis with real-world interpretation of home monitoring technologies including current adoption barriers and expanded future demands based on demographic and market forces. RESULTS Remote patient monitoring represents a paradigm shift in the way physicians care for patients. Success depends on meeting several criteria among which are a recognized value proposition to the physician, robust device performance validation, ease of use for the patient, reliability of connectivity, safe and secure data transmission, and economic feasibility. Ophthalmic diseases, such as age-related macular degeneration, glaucoma, and diabetic retinopathy, are ideal candidates for home monitoring practice integration. Established home monitoring technology is already facilitating early detection and improved visual outcomes for patients with age-related macular degeneration. Future innovation currently underway or on the horizon will continue to evolve and expand the footprint of telemedicine within ophthalmology. CONCLUSION Home monitoring has the potential to enhance the patient-physician relationship and to positively impact visual acuity outcomes in ophthalmic diseases. Advances in technology, demographic shifts, market changes, and patient demand for personalized medicine will require physicians to embrace technology in new and diverse ways, perhaps facilitating widespread adoption of home monitoring technology platforms.

      PubDate: 2017-11-14T08:35:03Z
      DOI: 10.1016/j.ajo.2017.11.003
       
  • Physical Activity and Age-related Macular Degeneration: A Systematic
           Literature Review and Meta-analysis
    • Authors: Lei Liu; Shivani Majithia; Yih-Chung Tham
      Abstract: Publication date: Available online 8 November 2017
      Source:American Journal of Ophthalmology
      Author(s): Lei Liu, Shivani Majithia, Yih-Chung Tham


      PubDate: 2017-11-14T08:35:03Z
      DOI: 10.1016/j.ajo.2017.10.013
       
  • Quantifying the Rate of Ellipsoid Zone Loss in Stargardt Disease
    • Authors: Cindy X. Cai; Jacob G. Light; James T. Handa
      Abstract: Publication date: Available online 7 November 2017
      Source:American Journal of Ophthalmology
      Author(s): Cindy X. Cai, Jacob G. Light, James T. Handa
      PURPOSE To determine a reliable method of using the ellipsoid zone (EZ) on optical coherence tomography (OCT) to track disease progression in Stardgardt disease (STGD). DESIGN retrospective reliability study METHODS STGD patients with genetically confirmed ABCA4 gene mutations seen at the Wilmer Eye Institute with follow-up visits separated by at least 12 months were identified. Spectral domain optical coherence tomography (SD-OCT) macula volume scans centered at the fovea and fundus autofluorescence (FAF) images were obtained. The area of EZ loss was calculated from the SD-OCT and the area of RPE loss from the FAF. Scans were re-analyzed by the primary grader to assess intra-grader reliability, and re-analyzed by a second grader to assess inter-grader reliability. RESULTS 16 STGD patients (total of 31 eyes) were followed for a mean of 2 years (range 1-4.7 years). The mean rate EZ loss, 0.31± 0.31mm2/year, was similar to the average rate of RPE loss, 0.33±0.38mm2/year. The average area of EZ loss at the initial examination, 4.18±1.9mm2/year, was larger than the initial area of RPE loss, 2.25±1.66mm2 (p < 0.01). The absolute difference of the area of EZ loss on test-retest for the first grader was 0.12±0.10mm2, and between graders 0.21±0.21mm2. The intraclass correlation (ICC) of both intra-grader as well as inter-grader reliability for EZ loss was excellent at 0.99. CONCLUSIONS Tracking the area of EZ loss on SD-OCT macular volume scans longitudinally is a reliable way of monitoring disease progression in STGD. This could be used as a sensitive anatomic outcome measure in clinical trials related to STGD.

      PubDate: 2017-11-14T08:35:03Z
      DOI: 10.1016/j.ajo.2017.10.032
       
  • Inter-observer agreement among uveitis experts on uveitic diagnoses: the
           Standardization of Uveitis Nomenclature (SUN) experience
    • Authors: Douglas A. Jabs; Andrew Dick; John T. Doucette; Amod Gupta; Susan Lightman; Peter McCluskey; Annabelle A. Okada; Alan G. Palestine; James T. Rosenbaum; Sophia M. Saleem; Jennifer Thorne; Brett Trusko
      Abstract: Publication date: Available online 6 November 2017
      Source:American Journal of Ophthalmology
      Author(s): Douglas A. Jabs, Andrew Dick, John T. Doucette, Amod Gupta, Susan Lightman, Peter McCluskey, Annabelle A. Okada, Alan G. Palestine, James T. Rosenbaum, Sophia M. Saleem, Jennifer Thorne, Brett Trusko
      Purpose To evaluate the interobserver agreement among uveitis experts on the diagnosis of the specific uveitic disease. Design Inter-observer agreement analysis Methods Five committees, each of 9 individuals, working in parallel, reviewed cases from a preliminary database of 25 uveitic diseases, collected by disease, and voted independently online whether the case was the disease in question or not. The agreement statistic, κ, was calculated for the 36 pairwise comparisons for each disease, and a mean κ was calculated for each disease. Following the independent online voting, committee consensus conference calls, using nominal group techniques, reviewed all cases not achieving supermajority agreement (>75%) on the diagnosis in the online voting to attempt to arrive at a supermajority agreement. Results A total of 5766 cases for the 25 diseases were evaluated. The overall mean κ for the entire project was 0.39 with disease-specific variation from 0.23 to 0.79. After the formalized consensus conference calls to address cases which did not achieve supermajority agreement in the online voting, supermajority agreement overall was reached on ∼99% of cases with disease-specific variation from 96 to 100%. Conclusions Agreement among uveitis experts on diagnosis is moderate at best but can be improved by discussion among them. These data suggest the need for validated and widely-used classification criteria in the field of uveitis.
      Teaser Agreement among uveitis experts on the diagnosis of 5766 cases for 25 diseases was moderate (overall mean κ=0.39), suggesting that groups of patients reported in the literature may not always be comparable. After formalized consensus conference calls, agreement was reached on 99% of cases, implying that validated and widely-used classification criteria for the uveitides may improve this situation.

      PubDate: 2017-11-14T08:35:03Z
      DOI: 10.1016/j.ajo.2017.10.028
       
  • AJO Centennial: Evolving concepts in the management of retinopathy of
           prematurity
    • Authors: Paul Sternberg; Alia K. Durrani
      Abstract: Publication date: Available online 3 November 2017
      Source:American Journal of Ophthalmology
      Author(s): Paul Sternberg, Alia K. Durrani
      Purpose The introduction of anti-vascular endothelial growth factor (VEGF) agents has stimulated considerable reexamination of treatment strategies for the management of retinopathy of prematurity (ROP). Herein we will summarize and review evolving concepts and provide a personal perspective on clinical management today and future directions of treatment. Design Literature Review Methods To synthesize the evolving management concepts for diagnosis and treatment of retinopathy of prematurity and to provide interpretation and perspective on current emerging therapies. Results Although initial treatment strategies focused on ablative therapy for threshold ROP, earlier treatment for type 1 or pre-threshold disease has been found to decrease unfavorable visual and structural outcomes. Vascular endothelial growth factor has emerged as a significant contributor to retinal-vascular diseases in the previous two decades. The potential role of anti-VEGF treatment for type 1 ROP has become a focus in recent years, but the protracted recurrence of disease and unknown adverse ocular and systemic effects have caused concern from some clinicians. In addition, the use of telemedicine technologies may provide the ability to screen remote areas with a shortage of ROP providers, thereby reducing the burden of disease. Conclusions The diagnosis and management of ROP has changed over the past 40 years; the role of anti-VEGF therapy remains to be established in current treatment strategies. Screening for initial disease and progression will likely be impacted by the increasing prevalence of telemedicine and relative shortage of clinicians.

      PubDate: 2017-11-07T03:24:58Z
      DOI: 10.1016/j.ajo.2017.10.027
       
  • Incidence and Etiology of Presumed Fourth Cranial Nerve Palsy: A
           Population-based Study
    • Authors: Eniolami O. Dosunmu; Sarah R. Hatt; David A. Leske; David O. Hodge; Jonathan M. Holmes
      Abstract: Publication date: Available online 2 November 2017
      Source:American Journal of Ophthalmology
      Author(s): Eniolami O. Dosunmu, Sarah R. Hatt, David A. Leske, David O. Hodge, Jonathan M. Holmes
      Purpose To determine the incidence of isolated, presumed fourth nerve palsy in a defined population, and to report the frequency of each cause. Design Retrospective, population-based case-series. Methods A population-based database was used to identify all cases of isolated fourth nerve palsy in Olmsted County, MN, USA diagnosed over a 15-year period (January 1, 1978 to December 31, 1992). The most likely etiology was determined by review of the entire medical record by two ophthalmologists. A priori definitions were applied for assigning cause. The incidence of fourth nerve palsy and the frequency of each etiology were calculated. Decade of life at presentation was recorded. Results 73 patients, (74 episodes, 70 [95%] unilateral) were identified. Mean age at presentation was 41.8 (range 3.3 to 81.6) years. The age- and gender-adjusted annual incidence rate was 5.73 per 100,000 per year (95% Confidence Interval [CI] 4.31-7.14). The most common etiology was presumed congenital (49%) followed by hypertension (18%) and trauma (18%). One patient (1%) had fourth nerve palsy due to a known intracranial neoplasm. For 3 patients (4%) the cause of fourth nerve palsy was undetermined. The most common decade of presentation overall was the fourth decade, including for presumed congenital cases. Conclusions In this population-based study, the majority of isolated fourth nerve palsies were presumed congenital, even though they presented throughout adulthood. Other etiologies such as hypertension and trauma were less frequent, and in no case was an isolated fourth nerve palsy the presenting sign of an intracranial tumor.

      PubDate: 2017-11-07T03:24:58Z
      DOI: 10.1016/j.ajo.2017.10.019
       
  • Development and Clinical Accuracy of a New IOL Power Formula (VRF)
           Compared to Other Formulas
    • Authors: Oleksiy V. Voytsekhivskyy
      Abstract: Publication date: Available online 2 November 2017
      Source:American Journal of Ophthalmology
      Author(s): Oleksiy V. Voytsekhivskyy
      Purpose To develop and compare the accuracy and reproducibility of the VRF IOL power calculation formula with well-known methods. Setting Kiev Clinical Ophthalmology Hospital Eye Microsurgery Center, Kiev, Ukraine. Design Development and validation study. Methods This analysis comprised 823 eyes of 823 patients operated on by one surgeon with three hydrophobic different types of lenses (IQ SN60WF (494 eyes), ReSTOR SN6AD1 (169 eyes), Alcon Labs, Fort Worth, TX, USA and AMO Tecnis MF ZMB00 (160 eyes), J&J, Santa-Ana, CA, USA). The full data set was divided into 2 subsets, the first to develop the new formula and second to evaluate theirperformance with other most commonly used modern methods of IOL power calculation (Haigis, Hoffer Q, Holladay 1, Holladay 2, SRK/T and T2).The VRF algorithm is empirical; it uses four predictors for estimation of postoperative lens position, including axial length (AL), corneal power (K), preoperative anterior chamber depth (corneal epithelium to lens) (ACD), and horizontal corneal diameter (CD). The results are also stratified into groups of short (≤22 mm), medium (>22 to <24.5 mm), medium-long (≥24.5 to <26 mm) and long (≥26 mm) axial length. Results The mean error (ME), median absolute error (MedAE), and mean absolute error (MAE) were evaluated for all seven methods with 1 IOL type. The VRF formula had the lowest median (0.305 D) absolute error over the entire axial length range, and was comparable with the formulas for T2 (0.321 D), and Holladay 1 (0.326 D). Conclusion: The new formula was comparable with well-known methods and was better over the entire axial length range.

      PubDate: 2017-11-07T03:24:58Z
      DOI: 10.1016/j.ajo.2017.10.020
       
  • Prevalence of Vision Impairment in Older adults in Rural China In 2014 and
           Comparisons with the 2006 China Nine-Province Survey
    • Authors: Jialiang Zhao; Xiao Xu; Leon B. Ellwein; Ning Cai; Huaijin Guan; Mingguang He; Ping Liu; Jianhua Lv; Xunlun Sheng; Peizeng Yang; Jinglin Yi; Mei Yang; Rui Zhang; Xiaohu Ding; Liping Du; Fengrong Li; Hong Lu; Wenqiang Shao;; Junwei Wang; Yuansheng Yuan; Rui Zhou; Wenjuan Zhuang; Lei An
      Abstract: Publication date: Available online 2 November 2017
      Source:American Journal of Ophthalmology
      Author(s): Jialiang Zhao, Xiao Xu, Leon B. Ellwein, Ning Cai, Huaijin Guan, Mingguang He, Ping Liu, Jianhua Lv, Xunlun Sheng, Peizeng Yang, Jinglin Yi, Mei Yang, Rui Zhang, Xiaohu Ding, Liping Du, Fengrong Li, Hong Lu, Wenqiang Shao;, Junwei Wang, Yuansheng Yuan, Rui Zhou, Wenjuan Zhuang, Lei An
      Purpose Estimate the prevalence of vision impairment and blindness in 2014 among older adults in rural China with comparisons with the 2006 Nine-Province Survey. Design Population-based, cross-sectional study. Methods Geographical cluster sampling was used in randomly selecting residents from a rural county or semi-rural district within nine provinces: Beijing, Jiangsu, Guangdong, Heilongjiang, Jiangxi, Hebei, Ningxia, Chongqing and Yunnan. Persons 50 years of age or older were enumerated through household visits and invited to examination sites for visual acuity testing and examination. Vision impairment and blindness in 2014 was compared with data from the 2006 survey. Results Among 51,310 examined persons, the prevalence of presenting vision impairment (<20/63 to ≥20/400) in the better-seeing eye ranged from 6.05% to 15.3% across the nine study sites, with presenting blindness (<20/400) ranging from 0.66% to 5.35%. With best-corrected visual acuity, the prevalence of vision impairment ranged from 1.96% to 8.74%, and blindness from 0.47% to 5.01%. Vision impairment was associated with older age, female gender, and little or no education. The overall prevalence of presenting vision impairment and blindness decreased during the 2006-2014 interval by 6.31% and 29.0%, respectively; and by 16.1% and 38.0%, respectively, after standardization of 2006 prevalence rates to the 2014 population. Conclusions Substantial progress has been made in the reduction of vision impairment in rural China. Nevertheless, it remains an important public health problem with substantial geographic disparities and with older age, female gender and illiteracy as risk factors.

      PubDate: 2017-11-07T03:24:58Z
      DOI: 10.1016/j.ajo.2017.10.016
       
  • Assessment of Optical Coherence Tomography Color Probability Codes in
           Myopic Glaucoma Eyes After Applying a Myopic Normative Database
    • Authors: Bo Ram Seol; Dong Myung Kim; Ki Ho Park; Jin Wook Jeoung
      Abstract: Publication date: Available online 2 November 2017
      Source:American Journal of Ophthalmology
      Author(s): Bo Ram Seol, Dong Myung Kim, Ki Ho Park, Jin Wook Jeoung


      PubDate: 2017-11-07T03:24:58Z
      DOI: 10.1016/j.ajo.2017.10.007
       
  • Ocular Manifestations of Familial Transthyretin Amyloidosis
    • Authors: Margaret Reynolds; Kevin Veverka Morie Gertz Angela Dispenzieri Steven Zeldenrust
      Abstract: Publication date: November 2017
      Source:American Journal of Ophthalmology, Volume 183
      Author(s): Margaret M. Reynolds, Kevin K. Veverka, Morie A. Gertz, Angela Dispenzieri, Steven R. Zeldenrust, Nelson Leung, Jose S. Pulido
      Purpose Among patients with familial amyloidosis, mutation in the transthyretin (TTR) protein is the most common type. Patients with TTR amyloidosis have been noted to have ocular, especially vitreous, involvement. In this report, an analysis of the types and frequency of ocular manifestations in TTR amyloidosis is presented. Design Observational case series. Methods Two hundred and sixty-three patients who presented to Mayo Clinic with TTR amyloidosis between January 1, 1970, and November 1, 2014, consented to be included in the Mayo Clinic amyloidosis database maintained by the Department of Hematology. Fifty-four patients had ocular examinations at a mean of 4.25 ± 3.93 months after systemic symptoms. Results Of 108 examined eyes in 54 patients with TTR amyloidosis, there were 26 eyes (24%) in 13 patients with ocular involvement. Patients with ocular involvement were more likely to be women than those without ocular involvement (46% vs 15%, respectively, P = .008) and have significantly worse visual acuity (VA) at presentation (logMAR 0.24 [Snellen equivalent 20/30] vs logMAR 0.00 [Snellen equivalent 20/20], P = .017). The ophthalmic findings included vitreous amyloid (26/26, 100%), neurotrophic keratitis (2/26, 8%), glaucoma (5/26, 19%), and tortuous retinal vessels (4/26, 15%). The glaucoma was classified as open-angle (2/26), exfoliative (2/26), and neovascular following central retinal vein occlusion from amyloidosis (1/26). Ten patients underwent vitrectomy for visually significant vitreous amyloidosis, which significantly improved VA from a baseline of logMAR 0.70 (Snellen equivalent 20/100) to logMAR 0.05 (Snellen equivalent ∼20/20), P = .003. Three TTR mutations, Glu89Lys, Gly47Arg, and homozygous Gly6Ser, not previously described, were associated with vitreous amyloid. Conclusion In this large cohort of patients with TTR amyloidosis, female sex and decreased VA were associated with ocular amyloid. Three mutations that have not been previously reported to have vitreous involvement were described: Glu89Lys, Gly47Arg, and homozygous Gly6Ser.

      PubDate: 2017-10-31T02:58:08Z
       
  • Reply
    • Authors: Peter Campochiaro; Tahreem Mir Yong Han Saleema Kherani Gulnar Hafiz
      Abstract: Publication date: November 2017
      Source:American Journal of Ophthalmology, Volume 183
      Author(s): Peter A. Campochiaro, Tahreem A. Mir, Yong S. Han, Saleema Kherani, Gulnar Hafiz, Claudia Krispel, T.Y. Alvin Liu, Jiangxia Wang, Adrienne W. Scott, Ingrid Zimmer-Galler


      PubDate: 2017-10-31T02:58:08Z
       
  • Reply
    • Authors: Ming Zhang; Mikee Liugan Zhaoyang
      Abstract: Publication date: November 2017
      Source:American Journal of Ophthalmology, Volume 183
      Author(s): Ming Zhang, Mikee Liugan, Zhaoyang Xu


      PubDate: 2017-10-31T02:58:08Z
       
  • Diabetic Choroidopathy: Choroidal Vascular Density and Volume in Diabetic
           Retinopathy with Swept-Source Optical Coherence Tomography
    • Authors: Jay Wang; Joana Grayson Armstrong Ana Santos Pedro Gil Gil
      Abstract: Publication date: Available online 6 October 2017
      Source:American Journal of Ophthalmology
      Author(s): Jay C. Wang, Inês Laíns, Joana Providência, Grayson W. Armstrong, Ana R. Santos, Pedro Gil, João Gil, Katherine E. Talcott, João H. Marques, João Figueira, Demetrios G. Vavvas, Ivana K. Kim, Joan W. Miller, Deeba Husain, Rufino Silva, John B. Miller
      Purpose To compare choroidal vascular density (CVD) and volume (CVV) in diabetic eyes and controls, using en face swept-source optical coherence tomography (SS-OCT). Design Prospective cross-sectional study. Methods ▪▪▪ Setting Multicenter Patient Population 143 diabetic eyes – 27 with no diabetic retinopathy (DR), 47 with nonproliferative DR (NPDR), 51 with NPDR and diabetic macular edema (DME), and 18 with proliferative DR (PDR), and 64 age-matched non-diabetic control eyes. Observation procedures Complete ophthalmologic examination and SS-OCT imaging. En face SS-OCT images of the choroidal vasculature were binarized. Main outcome measures CVD, calculated as the percent area occupied by choroidal vessels in the central macular region (6-mm diameter circle centered on the fovea), and throughout the posterior pole (12 x 9 mm). The central macular CVV was calculated by multiplying the average CVD by macular area and choroidal thickness (obtained with SS-OCT automated software). Multilevel mixed linear models were performed for analyses. Results Compared to controls (0.31 ± 0.07), central macular CVD was significantly decreased by 9% in eyes with NPDR + DME (0.28 ± 0.06; ß=-0.03, p=0.02) and by 15% in PDR (0.26 ± 0.05; ß= -0.04, p=0.01). The central macular CVV was significantly decreased by 19% in eyes with PDR (0.020 mm3 ± 0.005 mm3, ß = -0.01, p=0.01) compared to controls (0.025 mm3 ± 0.01 mm3). Conclusions Choroidal vascular density and volume are significantly reduced in more advanced stages of diabetic retinopathy. New imaging modalities should allow further exploration of the contributions of choroidal vessel disease to diabetic eye disease pathogenesis, prognosis, and treatment response.

      PubDate: 2017-10-10T14:05:22Z
       
  • Outcomes and Prognostic Factors of Cataract Surgery in Adult Extreme
           Microphthalmos with Axial Length <18 mm or Corneal Diameter <8 mm
    • Authors: Tianyu Zheng; Zhanghua Chen Jie Yating Tang Fan
      Abstract: Publication date: Available online 6 October 2017
      Source:American Journal of Ophthalmology
      Author(s): Tianyu Zheng, Zhanghua Chen, Jie Xu, Yating Tang, Qi Fan, Yi Lu
      Purpose To study the long-term visual outcomes, complications and prognostic factors for cataract surgery in extreme microphthalmos. Design Prospective cohort study. Methods Thirty eyes with simple microphthalmos [11 eyes, axial length (AL) <18 mm], complex microphthalmos [8 eyes, AL <18 mm] and relative anterior microphthalmos [RAM, 11 eyes, corneal diameter (CD) <8 mm] who underwent cataract surgery (phacoemulsification) in our hospital were followed for a mean of 25.3 months with at least three visits at early (1 day-1 week), mid (1-3 months) and late (>6 months) stages after surgery. The main outcome measures included the best-corrected visual acuity (BCVA), intraocular pressure (IOP) and complications. Results Significant improvements of BCVA were observed at the mid- and late postoperative visits in the entire cohort when compared with preoperative value (p<0.05). When divided into three groups, a statistically significant improvement in late-stage BCVA was observed in the simple microphthalmos and RAM groups. The AL, preoperative ACD and preoperative BCVA were significant prognostic factors for late-stage BCVA after surgery. The most common complications were early corneal edema (73%), glaucoma (33%) and posterior capsular opacification (23%). Preoperative ACD was significantly associated with the incidence of glaucoma after surgery (p<0.05). Severe complications included suprachoroidal hemorrhage (3%), endothelial dysfunction (7%) and retinal detachment (7%). Conclusions Cataract surgery provided visual improvement in extreme microphthalmos (simple microphthalmos and RAM), with higher risks of complications than with routine cataract surgeries. Extreme microphthalmos with preoperative characteristics of relatively longer AL, deeper ACD and better BCVA may benefit more from cataract surgery.

      PubDate: 2017-10-10T14:05:22Z
       
  • Choroidal Thinning Associated with Hydroxychloroquine Retinopathy
    • Authors: Seong Joon Ahn; So Jung Ryu; Joo Young Joung; Byung Ro Lee
      Abstract: Publication date: Available online 8 September 2017
      Source:American Journal of Ophthalmology
      Author(s): Seong Joon Ahn, So Jung Ryu, Joo Young Joung, Byung Ro Lee
      Purpose To investigate choroidal thickness in patients using hydroxychloroquine (HCQ) and compare choroidal thickness between eyes with and without HCQ retinopathy. Design Retrospective case series Methods Setting: Institutional Patients: We included 124 patients with systemic lupus erythematosus or rheumatoid arthritis who were treated with HCQ. The patients were divided into an HCQ retinopathy group and a control group, according to the presence or absence of HCQ retinopathy. Observation: Total choroidal thickness and choriocapillaris-equivalent thickness were measured manually by two independent investigators using swept-source optical coherence tomography (SS-OCT; DRI-OCT, Topcon Inc., Tokyo, Japan). These measurements were made at the fovea and at nasal and temporal locations 0.5, 1.5, and 3 mm from the fovea. Medium-to-large vessel layer thickness was calculated accordingly. The thicknesses were compared between the HCQ retinopathy and control groups. We performed correlation analyses between choroidal thicknesses and details regarding HCQ use. Main outcome measures: Total choroidal thickness and choriocapillaris-equivalent thickness Results Choroidal thicknesses were significantly decreased (P<.05) in the HCQ retinopathy group compared to the control group except at the temporal choroid 1.5 mm from the fovea. Choriocapillaris-equivalent thicknesses were significantly different in all choroidal locations between the groups. In contrast, the medium-to-large vessel layer thickness was only significantly different at a few locations. The cumulative dose/body weight was significantly correlated with subfoveal choroidal and choriocapillaris-equivalent thicknesses (both P=.001). The association between presence of HCQ retinopathy and choroidal thicknesses was also statistically significant after adjusting for age, diagnosis for HCQ use, refractive errors, and duration of HCQ use (P=.001 and .003 for subfoveal choroidal and choriocapillaris-equivalent thickness, respectively). Conclusions These results all suggest that HCQ retinopathy is associated with choroidal thinning, especially in the choriocapillaris. Our results may suggest choroidal involvement of HCQ toxicity.

      PubDate: 2017-09-14T02:13:10Z
      DOI: 10.1016/j.ajo.2017.08.022
       
  • Analysis of Cytokine levels in tears and Clinical Correlations after
           Intense Pulsed Light Treating Meibomian Gland Dysfunction
    • Authors: Ruixing Liu; Bei Rong; Ping Tu; Yun Tang; Wenjing Song; Toyos Rolando; Toyos Melissa; Xiaoming Yan
      Abstract: Publication date: Available online 6 September 2017
      Source:American Journal of Ophthalmology
      Author(s): Ruixing Liu, Bei Rong, Ping Tu, Yun Tang, Wenjing Song, Toyos Rolando, Toyos Melissa, Xiaoming Yan
      Purpose To investigate the change from baseline of inflammatory markers in tears of dry eye disease(DED) subjects due to meibomian gland dysfunction(MGD) after IPL(intense pulsed light) treatment and meibomian gland expression(MGE) compared to sham treatment, and the correlations with ocular surface parameters. Design Randomized, double-masked, controlled study. Methods Those randomized into the active treatment arm received 3 consecutive treatments(14∼16J/cm2) approximately 4 weeks apart in the periocular region. Control eyes received 3 treatments in the same intervals of 0J/cm2. Tear samples in all eyes were collected and analyzed at baseline, Week 12 and/or Week 4 for interleukin(IL)-17A, interleukin(IL)-6, and prostaglandin E2(PGE2).The correlations between cytokines and ocular surface parameters were analyzed before and after IPL treatment. Results All of the inflammatory markers declined in value compared to baselines. IL-17A and IL-6 showed statistically significant decreases compared to sham treatment at each measured time point. PGE2 showed statistically significant decreases compared to sham at Week 12. Results showed that the expressions of IL-17A and IL-6 correlated well with ocular surface parameters of the lower eyelid before IPL. The changed values of IL-6 and PGE2 in tears correlated with the changed values of partial ocular surface parameters after IPL treatment in study eyes, respectively. Conclusions The study results suggest IPL can significantly reduce inflammatory markers in tears of patients suffering with DED due to MGD after IPL treatment. These findings indicates that IL-17A and IL-6 play roles in the pathogenesis of DED due to MGD, and the reduction of the inflammatory factors is consistent with the improvement of partial clinical symptoms and signs.

      PubDate: 2017-09-08T01:52:00Z
      DOI: 10.1016/j.ajo.2017.08.021
       
  • Primary (Month-6) Outcomes of the STOP-Uveitis Study: Evaluating the
           Safety, Tolerability, and Efficacy of Tocilizumab in Patients with
           Non-Infectious Uveitis
    • Authors: Yasir Jamal Sepah; Mohammad Ali Sadiq; David S. Chu; Mark Dacey; Ron Gallemore; Pouya Dayani; Mostafa Hanout; Muhammad Hassan; Rubbia Afridi; Aniruddha Agarwal; Muhammad Sohail Halim; Diana V. Do; Quan Dong Nguyen
      Abstract: Publication date: Available online 5 September 2017
      Source:American Journal of Ophthalmology
      Author(s): Yasir Jamal Sepah, Mohammad Ali Sadiq, David S. Chu, Mark Dacey, Ron Gallemore, Pouya Dayani, Mostafa Hanout, Muhammad Hassan, Rubbia Afridi, Aniruddha Agarwal, Muhammad Sohail Halim, Diana V. Do, Quan Dong Nguyen
      Purpose To report the primary end-point analyses of the safety and efficacy of two different doses of intravenous (IV) infusions of tocilizumab (TCZ), an IL-6 inhibitor, in eyes with non-infectious intermediate, posterior or pan-uveitis. Design Randomized, controlled, multicenter clinical trial. Methods STOP-Uveitis is a randomized, open-label safety, efficacy and bioactivity clinical trial conducted at 5 clinical centers across the United States. The study evaluated the role of TCZ in patients with non-infectious uveitis (NIU). 37 Patients with NIU were randomized into one of 2 treatment groups in a ratio of 1:1. Group 1 received intravenous (IV) infusions of 4mg/kg TCZ and group 2 received IV infusions of 8mg/kg TCZ. Infusions were given every 4 weeks in both groups until month 6 (primary endpoint). Primary outcome measure was incidence and severity of systemic and ocular adverse events through month 6. Secondary outcome measures included mean change in visual acuity (VA), vitreous haze (VH) and central macular thickness (CMT) at month 6. Results A total of 37 patients were randomized in the study. At month 6, 43.5% of patients who had the potential for a 2-step decrease in VH, demonstrated a 2-step decrease (40% in group 1 and 46.1% in group 2). Mean change in CMT was -83.88 ± 136.1μm at month 6 (-131.5 ± 41.56μm in group 1 and -38.92 ± 13.7μm in group 2). Mean change in VA was +8.22 ± 11.83 ETDRS letters at month 6 (10.9 ± 14.6 in group 1 and 5.5 ± 7.8 in group 2). Repeated infusions of TCZ were well tolerated. Conclusions Repeated IV administrations of TCZ are well tolerated. TCZ (both 4 and 8 mg/kg) is effective in improving VA and reducing VH and CMT in eyes with non-infectious intermediate, posterior and pan-uveitis.

      PubDate: 2017-09-08T01:52:00Z
      DOI: 10.1016/j.ajo.2017.08.019
       
 
 
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